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Family Meals Focus

The Ellyn Satter Institute Newsletter

Versions of internally regulated eating

by Ellyn Satter, Registered Dietitian and Family Therapist

Both the Satter Eating Competence Model (edSatter) and Intuitive Eating (IE) are models supporting internally regulated eating. Both are based on permission, which is essential for addressing negative and conflicted eating attitudes and behaviors: Permission to eat as much as you want and what you want. Mindful eating (ME) may or may not give permission, depending on the food politics of the practitioner. ecSatter defines structure as integral and essential. IE encourages eating on demand, and ME has no guidelines.

Not all approaches are the same 

A reader’s question: “In the process of studying non-dieting and health at every size. We started with Eating Competence, and my students and colleagues asked about Intuitive Eating and Mindful eating. It sounds like IE and ME fit nicely with your ideas, but I was wondering what you thought.

The fundamental principle of non-dieting and health at every size is internally regulated eating. While both Satter Eating Competence Model (ecSatter) and Intuitive Eating (IE) support internally regulated eating, it is unclear about “mindful eating” (ME.) ME is undefined and may used self-awareness as a method to promote either size acceptance or weight loss. The term “mindful eating” can be used as a descriptor denoting the tuned-in, self-aware eating that is a part of both ecSatter and IE. The reader’s question, however, appears todescribe ME as a stand-alone idea, and that is how I will use the term.  

Model or idea?

There is a major difference between a model and an idea. A model is a cohesive set of evidence-based theoretical principles that can be objectively tested. An idea has none of those characteristics. ecSatter is a model. It is cohesive, based on theory and evidence, concretely described,1 and examined by a validated test.2 Tribole and Resch’s Intuitive Eating3 is also a model: it is well-defined, evidence based, and has a validated test.4 ME is a vaguely and variously defined idea that gets picked up by people and programs, seemingly to describe attentive, internally regulated eating. It doesn’t have a test, and it hasn’t been tested. I won’t include the term non-dieting in this review because it is vague, is characterized by what it isn’t rather than what it is, and is readily misused by weight loss programs and food-control schemes that aren’t exactly diets.  

Comparing ecSatter, IE, and ME

The two key elements of ecSatter are discipline and permission:1

  • The discipline of providing yourself with regular, reliable, and rewarding meals and snacks and paying attention while you eat.
  • The permission to eat what and as much as you want at those regular eating times.

The three elements of IE3 are:

  • Unconditional permission to eat.
  • Eating for physical rather than emotional reasons.
  • Reliance on internal hunger/satiety cues.

What ME seems to do:

  • Tune in while eating.

Permission and discipline

Both ecSatter and IE are based on permission, which is essential for addressing negative and conflicted eating attitudes and behaviors: Permission to eat as much as you want and what you want. ME may or may not give permission, depending on the food politics of the practitioner. With respect to discipline, ecSatter alone defines structure as integral and essential to the model.5 Instead of structure, IE essentially encourages eating on demand,3 seemingly seeing structure as imposing external rules for inner experience and therefore being tantamount to restriction. However, IE and ME are not discipline-free. The same as ecSatter, during eating, both emphasize the discipline of being tuned in to self, food, and eating.

To ecSatter, structure is critical

  • Structure supports permission to eat and allows forgetting about eating between times.
  • Structure supports family meals, which potentiate the ability to regulate food intake and learn to eat a variety of food.
  • Structured meals and snacks support eating as a social activity and is therefore developmentally appropriate for anyone beyond infancy.
  • Structured meals and snacks are essential for following the division of responsibility in feeding.

Size acceptance? Internal regulation of food intake? 

ecSatter encourages weighing “what you will” in response to positive and self-respecting eating, including self-aware and deliberate eating for emotional reasons.1 IE’s “eating for physical rather than emotional reasons”3 raises the possibility of weight loss. The IE assumption may be that the body doesn’t “remember” calorie intake from emotional eating or calorie deficit from stopping emotional eating and will gain or lose weight accordingly. ME varies by practitioner and comes down on all sides of the consideration, with some practitioners promising weight loss and others promoting size acceptance.

Nutritional guidance  

Addressing nutrition without taking away permission to eat is a dilemma with any method that aims to address conflict and anxiety relative to eating. Many practitioners resolve the dilemma by not addressing nutrition and food selection. Nutritional excellence is and always has been an integral component of ecSatter. As described in Satter’s Hierarchy of Food Needs,6 dietary quality is an experientially evolving process that sequentially builds on successfully providing oneself with enough to eat of rewarding food.

IE Principle 10, “Honor Your Health,” addresses “gentle nutrition.”3 It encourages eating “what you really want” and savoring food. Nutritional excellence appears to be a separate process: “In matters of taste, consider nutrition; in matters of nutrition, consider taste.”

It is anybody’s guess how ME practitioners address nutrition.

Treatment approaches vary

How do ecSatter, IE, and ME differ with respect to treatment of established distortions in eating attitudes and behavior? The ecSatter-based “How to Eat” method7 uses evidence-based cognitive-behavioral methods to support recovery from trauma around eating and regain positive eating attitudes and internal regulation capabilities. Treatment emphasizes the acceptance of all foods, including “forbidden” foods. Methods include in-session desensitization training, reframing, self-awareness and self-acceptance training, and discovery in the course of take-home assignments.

IE encourages unconditional permission to eat3 – what you want, when you want, as much as you want. The task is to be in constant touch with hunger and appetite, eating immediately when hunger reaches a critical, subjectively defined level, and eating the food that is appealing at that moment. A related idea is allowing unlimited amounts of “forbidden” foods until the foods’ fear potential is neutralized and moderate and stable eating evolves. Clinically, IE depends on in-session teaching, discussion, and encouragement to replace negative eating attitudes and behaviors with positive ones.

Treatment with ME varies depending on the practitioner. 

Respecting the models is critical for research

We need responsible and rigorous research if we are to displace negative and controlling eating management with kinder, gentler ways. Research depends on well-defined, evidence-based models. Moreover, the constraints of a given model must be absolutely respected, with no improvising or substituting. I put my name on ecSatter to protect it from appropriation and amendment. As a model, ecSatter is only effective when all the elements are in place. The same holds true for IE. Because ME is so vaguely defined, it can’t be researched. In her excellent studies on non-dieting, Linda Bacon8 called her eating management approach “intuitive eating,” although she neither credited Tribole and Resch nor use their model. She used a combination of stop-dieting/size-acceptance education and persuasion and a compendium of nutritional strategies. As a result, she researched non-dieting in combination with an idea for food management.  

This is not to say that we have to reject ideas. Certainly we have all been inspired by the work of others, and we all benefit from remembering whose conceptual shoulders we stand on. While none of them created models that we can research, I was still helped out of my conventional rut by Hirschmann and Munter’s Overcoming Overeating, who in turn were influenced by Kano’s Making Peace with Food. Or maybe it was the other way around, and somewhere in there was Roth’s Feeding the Hungry Heart. You undoubtedly were influenced by others, and that is good. However, for research, education, and clinical work, you are wise to use a model. Your work can only be understood and replicated when you clearly define what you do.  

References

  1. Satter EM. Eating Competence: definition and evidence for the Satter Eating Competence Model. J Nutr Educ Behav. 2007;39:S142-S153.
  2. Lohse B, Satter E, Horacek T, Gebreselassie T, Oakland MJ. Measuring eating competence: psychometric properties and validity of the ecSatter Inventory. J Nutr Educ Behav. 2007;39(5 Suppl):S154-166.
  3. Tribole E, Resch E. Intuitive Eating; A revolutionary program that works. New York: St. Martin’s Griffin; 2012.
  4. Tylka, T. L. and A. M. Kroon Van Diest (2013). “The Intuitive Eating Scale-2: item refinement and psychometric evaluation with college women and men.” J Couns Psychol 60(1): 137-153.
  5. Satter EM. Chapter 5, Feed yourself faithfully. Secrets of Feeding a Healthy Family: How to Eat, How to Raise Good Eaters, How to Cook. Madison, WI: Kelcy Press; 2008:45-50.
  6. Satter E. Hierarchy of food needs. J Nutr Educ Behav. 2007;39(5 Suppl):S187-188.
  7. Satter EM. Chapter 4, Eat as Much as You Want. Secrets of Feeding a Healthy Family: How to Eat, How to Raise Good Eaters, How to Cook. Madison, WI: Kelcy Press; 2008:27-43.
  8. Bacon L. Health at Every Size: The Surprising Truth About Your Weight. Callas, TX: BenBella Books; 2008.

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