Family Meals Focus
The Ellyn Satter Institute Newsletter
Counseling with the Satter Eating Competence Model (ecSatter)
by Ellyn Satter, Registered Dietitian and Family Therapist
Conventional nutrition education is head learning: what to eat, correct portion sizes, prepare it this way. In contrast, you learn eating competence with your body. To become eating competent, you need new ways of experiencing food so you can respond to it in different and more positive ways. Most of all, you need permission to eat as much as you want of food you enjoy and to share pleasant eating times with others.1
Move away from discussing good-food-bad-food
You learn eating competence with your body. To become eating competent, you need new ways of experiencing food so you can respond to it positively.
Most people come to nutrition counseling wanting advice about food selection and doing good-food-bad-food thinking, because that is what we have taught them. For years, we have been saying, essentially, eat this and you will be healthy, don’t eat that or you will be sick. To interest them in eating competence, begin by asking questions that address the experience of eating.
- How do you see to it that you get fed? This addresses eating management overall and emphasizes the bottom line of eating competence: being reliable about feeding themselves.
- How do you feel about eating that way? For instance, does your grazing and eating in a hit-or-miss fashion work for you?
- What would you like to be different? Don’t settle for food selection answers. Keep asking until you get eating competence answers: feeling better about food and weight, being less picky, not being so troubled about how much to eat or how much to weight, having more enjoyable family meals, resolving wants/shoulds conflict with food selection.
Coming out of this general discussion, continue to focus the session on eating attitudes and behaviors rather than on food selection. Do they have regular meals? Do they plan for feeding themselves? Are they comfortable with their enjoyment of food and eating? Are they interested in new food, and can they experiment with it? Do they trust themselves to eat enough for them?
Introduce the possibilities
Along with your interview, giving and scoring ecSI 2.0 can give you some clues to where your client or audience is having particular difficulties. (But don’t go over the questionnaire with them. That spoils its utility for after-intervention testing.) A score of 32 or above on ecSI 2.0 indicates they are doing well with eating: they feed themselves reliably, are comfortable with enjoying eating, they seek out new food, and are tuned in to their hunger, appetite and satiety. Maybe they just need to get out from under their draconian rules about food selection or weight, or maybe they need you to give their food your blessings. On the other hand, a score in the teens, combined with interview evidence of serous conflict and anxiety about eating, is likely to mean this person requires treatment, not primary intervention.
Most gaps are in any of the ecSI 2.0 factors: the person might think she should have more home-cooked meals, eat more vegetables, avoid sweets, or make fewer fast-food jaunts. Your job is to get the “shoulds” out. “If eating that way worked for you, you would have done it already. You can guilt-trip yourself into doing those things, but it won’t last.” With people who want such general help with eating management, most change can revolve around building family meals. “It seems to me that all of the things you want to change relate to meals. Shall we start by taking a look at meals?” Depending on their eating patterns, you might help them get the meal habit by putting structure around what they are currently eating, at the one extreme, or encouraging them to tone down their nutritional over-zealousness, on the other. In the process, you will discover opportunities to neutralize other areas of rigidity, such as by showing them how to include forbidden food or encouraging them to use enough fat and salt in cooking to make their food taste good. Studying the foundational article3 about the definition and evidence for ecSatter will deepen your understanding of eating dynamics so you can address eating attitudes and behaviors. You can also learn from your clients. Once they get the idea of providing structure paired with permission to eat, they will be creative about eating – and thinking and feeling about eating.
Some people have entrenched eating problems
Most eating problems can be addressed with primary intervention: the brief education and counseling we have been discussing. 2 The person gets it, they go off and make progress on their own, they do some background reading – or not, they come back – or not. If you see them again, you go by what they are working on: you do a bit of encouraging and/or tuning up. Others require secondary Intervention. their eating problems are pronounced and entrenched. Their ecSI 2.0 is likely to be low, they are seriously upset, the problem is long-standing, and they have tried many solutions without success. Typically, these difficult issues relate to subcategories of ecSI 2.0: to food acceptance or food regulation. They may be a chronic failed dieter, be a seriously picky eater, binge and purge, have unstable weight, and/or have pronounced body dissatisfaction. Those folks require and treatment plan and several-session, systematic followup addressing their eating attitudes and behaviors. The How to Eat method, which I describe in Secrets of Feeding a Healthy Family,4 has had considerable clinical success with the problems I just described. ESI teaches that method in the Treating the Dieting Casualty VISION workshop.
Addressing eating instead of teaching food selection takes a lot of re-learning
As one of my colleagues said when she was struggling to master counseling with eating competence, “sometimes I would just like to go back to telling them what to eat.” You may feel the same. However, once you gain an appetite, so to speak, for the relationships and dynamics of working with eating competence, you won’t want to go back! Keep in mind that for many people, your giving your blessings is enough. In social work graduate school, I learned to make strategic use of myself in helping my patients. Your attitude can heal when you are accepting of your client and their relationship with food, and have the calm conviction that it is okay for them to trust themselves and experience joy from eating. At whatever your level of intervention, your regard and strategic assistance will help set them free to learn and grow on their own.
1. Satter EM; Appendix C, What Surveys Say about our Eating. Secrets of Feeding a Healthy Family: How to Eat, How to Raise Good Eaters, How to Cook. Madison, WI: Kelcy Press ; 2008.
For examples of language and approaches to use to teach eating competence, see Ellyn Satter’s Secrets of Feeding a Healthy Family: How to Eat, How to Raise Good Eaters, How to Cook.
To watch Ellyn Satter do nutrition counseling based on the ecSatter, see the Satter Eating Competence Model Webcast Series on CD.
Related issues of Family Meals Focus
- Eating competence
- Eating competence: Context-management skills
- Eating competence: Eating attitudes
- Eating competence: food acceptance
- Eating competence: internal regulation
- Eating competence: putting it all together
- Emotional eating
- Versions of internally regulated eating