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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 weigh, having more enjoyable family meals, resolving wants/shoulds conflict with food selection. 

Consider using ecSI

The Satter Eating Competence Inventory (ecSI) asks the right questions and can help 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? Can they experiment with new food and learn to like it? Do they trust themselves to eat enough for them?  Of the 16 items in ecSI, only one addresses food selection, and that obliquely: “I consider what is good for me when I eat.” Eating competent people eat nutritious foods because they enjoy them, not just because they are good for them.   

Introduce the possibilities

Asking the right questions exposes capabilities – or gaps.

  • You might observe that they do well with eating: they feed themselves reliably, enjoy food and seek out new food, are tuned in to their hunger, appetite and satiety, and maintain consistent weight. Maybe they just need to get out from under their draconian rules about food selection, or maybe they need you to give their food your blessings.
  • Other gaps might be in any of the ecSI 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 established eating problems

Most eating problems can be addressed with brief intervention: essentially, doing education.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. But for others, eating problems are more difficult. Their ecSI score may 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: 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 low physical self esteem. For such people, secondary intervention is in order. After careful assessment, they require a specific eating competence based treatment plan and followup addressing their eating problem. Consider taking the Treating the Dieting Casualty VISION Workshop. It teaches 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. 

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 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. 

References

 

 

 

 

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.

2. Satter EM. Nutrition education with the Satter Eating Competence Model. J Nutr Educ Behav. 2007;39 (suppl):S189-S194.

2. Satter EM. Eating Competence: definition and evidence for the Satter Eating Competence Model. J Nutr Educ Behav. 2007;39:S142-S153.

4. Satter EM. How to Eat,” In Secrets of Feeding a Healthy Family: How to Eat, How to Raise Good Eaters, How to Cook. Madison, WI: Kelcy Press; 2008:31-37.

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