Family Meals Focus
The Ellyn Satter Institute Newsletter
ecSI 2.0 gives insight on eating disorders
by Ellyn Satter, MS, MSSW, Nutritionist and Family Therapist
ecSI 2.01 can be used to screen for eating dysfunction and disorders. As with any inventory, diagnosis must be supported by further evidence. Validation studies correlating high scores on ecSI 2.0 with scores on other inventories show inverse correlations with eating disorder symptoms2-4 as well as significantly lower restraint, disinhibition and hunger intolerance.5 Cognitive interviews reveal dysfunctional eating attitudes and behaviors attitudes in low-income women who score low on ecSI.6 Identifying specific ecSI 2.0 cutoffs for eating disorder diagnoses warrants further study.
The Garner Eating Disorder Inventory
ecSI 2.0 scores in the lowest tertile correlate strongly with eating disordered scores on the Garner Eating Disorder Inventory 3.2, 3 Conversely, scores in the upper ecSI 2.0 tertile correlate with normative ranges of EDI scores.2, 3 A person who scores in the lowest ecSI 2.0 tertile (16 or below) may exhibit eating, body image, and psychosocial attitudes and behaviors associated with eating disorders. EDI 3 captures not only attitudes and behaviors directly related to eating, but also symptoms of underlying psychosocial distortion, with each exacerbating the other.2 As Hilde Bruch observed, an eating disorder is “the misuse of eating in an attempt to solve or camouflage problems of daily living that seem otherwise insoluble.”7
- Body dissatisfaction
- Low Self-esteem
- Personal alienation
- Interpersonal insecurity
- Interpersonal alienation
- Emotional dysregulation
- Maturity fears
- Interoceptive deficits
- Maturity fears
Stunkard’s Three Factor Eating Questionnaire (TFEQ)
TFEQ5 tests for eating behaviors characteristic of eating disorders as well as normative distortions in eating attitudes and behaviors. That is, TFEQ tests for the antithesis of ecSatter: cognitive restraint with eating, disinhibition of restraint, and difficulty coping with hunger. Eating Competent subjects score in the “free eater” range for all three.3, 4 EC subjects trust their internal regulators of hunger, appetite and satiety and tolerate between-meal hunger, not from willpower, but from a pleasant anticipation of the next satisfying meal or snack.8
The Eating Competence interview study
Cognitive interviews with low-income women6 reveal striking attitudinal differences between low-income women who score high and those who score low on ecSI. Women who score high relate their eating to energy, excitement, enjoyment, happiness, and relaxation. Those who score low report eating-disorder-typical eating attitudes and behaviors:
- Negative thoughts and feelings about eating
- Making weight management primary
- Emphasizing restricting and avoiding food
- Eating in a disorganized, inattentive fashion
- Being distressed about failure to adhere to food management standards
Eating disorder attitudes and behavior are the antithesis of Eating Competence
- Do people with eating disorders celebrate eating? Hardly. To feel good about eating means it could go out of control!
- Do they enjoy food? No, food enjoyment is particularly hazardous because it can undermine rigid control.
- Do they let themselves eat food they enjoy? Not at all! Since they are trying to restrict, they experience appetite as unbearably compelling and never satisfied.
- Do they eat as much as they want? Horrors! The goal of the person with anorexia is to not eat very much.
- Do they feed themselves positively, regularly, and reliably? Not likely! Every food exposure brings with it the possibility of out-of-control eating.
- Is there a secondary benefit to all this misery? By all means! Eating becomes so engrossing that it distracts from the underlying life misery that they regard, likely unconsciously, as being even worse.
Using ecSI 2.0 to screen for eating disorders
A person who scores in the lowest tertile of ecSI 2.0 (16 or below)3 may exhibit dysfunctional eating, body image, and psychosocial attitudes and behaviors associated with eating disorders. However, as with any inventory, you must support any diagnosis with further evidence.
- Use EDI-32or the validated and no-cost EAT-269 along with ecSI 2.0 to communicate with the eating disorders world, demonstrate credence of ecSI 2.0 scores.
- Cautiously interpret low inventory scores, even in combination. Only clinical examination can determine whether the person truly has an eating disorder.
- Until the scoring norms are established by further research, help accumulate a body of knowledge about typical ecSI 2.0 scores and symptoms of disordered eating symptoms. ESI Faculty Member Cristen Harris can help. She does training on doing clinical research10 and can compile your ecSatter-based data with that of others and get your contribution into print.
- Because ecSI 2.0 has been demonstrated to have test/retest reliability,11 you may administer ecSI 2.0 before, during, and after intervention to support evidence-based clinical practice.
- Lohse B. The Satter Eating Competence Inventory for Low-income persons is a valid measure of Eating Competence for persons of higher socioeconomic position. Appetite. 2015;87:223-228.
- Garner DM. Eating Disorders Inventory 3. Psychological Assessment Resources, Inc.; 2000.
- Krall JS, Lohse B. Validation of a measure of the Satter eating competence model with low-income females. Int J Behav Nutr Phys Act. 2011;8:26-36.
- Lohse B, Satter E, Horacek T, et al. Measuring eating competence: psychometric properties and validity of the ecSatter Inventory. J Nutr Educ Behav. 2007;39:S154-S166.
- Stunkard AJ, Messick S. The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. J Psychosom Res. 1985;29(1):71-83.
- Krall JS, Lohse B. Cognitive testing with female nutrition and education assistance program participants informs validity of the Satter eating competence inventory. J Nutr Educ Behav. Jul-Aug 2010;42(4):277-83.
- Bruch H. Eating Disorders: Obesity, Anorexia Nervosa and the Person Within. Basic Books; 1973.
- Satter E. Eating Competence: definition and evidence for the Satter Eating Competence Model. J Nutr Educ Behav. 2007;39:S142-S153.
- Garner DM, Olmsted MP, Bohr Y, et al. The eating attitudes test: psychometric features and clinical correlates. Psychol Med. Nov 1982;12(4):871-8.
- Harris C. ESI webinar. Researching Satter: Strengthening the Evidence-Base for the Satter Models. Accessed May 20, 2021, https://www.ellynsatterinstitute.org/product/prof-web-evidence/
- Stotts JL, Lohse B. Reliability of the ecSatter Inventory as a tool to measure eating competence. J Nutr Educ Behav. Sep-Oct 2007;39:S167-70.