Family Meals Focus
The Ellyn Satter Institute Newsletter
What does Satter Eating Competence Model research say about eating disorders?
by Ellyn Satter, Nutritionist and Family Therapist
To the extent that we urge, persuade, and guilt-trip ourselves and others to eat certain amounts and types of food and force our bodies to turn out a certain way, we all contribute to distortion, conflict, and anxiety with respect to eating. This is not to say that we cause eating disorders. Distorted eating attitudes and behaviors are symptoms of underlying psychosocial distortion, with each exacerbating the other. 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.”1
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 and trust appetite? Not at all! Since they are trying not to eat, they experience appetite as unbearably compelling and never satisfied.
- Do they eat enjoyable food? No, such food is particularly hazardous because it can undermine rigid control.
- Do they eat as much as they want? Horrors! The goal of the person with anorexia or bulimia is to not eat very much.
- Do they feed themselves regularly and reliably? Not likely! They experience eating as being so negative that they would forget about it if they could.
- 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.
Subjects with high eating competence subjects score low on TFEQ
Two well-known validated tests addressing eating attitudes and behavior were among the instruments used to validate both the original2 and the updated3 ecSI 2.0TM : Stunkard’s Three Factor Eating Questionnaire (TFEQ)4 and Garner’s Eating Disorders Inventory (EDI).5,6 From the perspective that achieving a particular body weight requires ignoring and overruling internal regulators, TFEQ tests for cognitive restraint with eating, disinhibition of restraint, and coping with hunger. EC subjects score in the “free eater” range for all three. 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.
Subjects with high eating competence score low on EDI
Validation with EDI-26 and EDI-35 allow direct comparison of ecSI 2.0TM scores with eating disorder indicators. EDI-26 and EDI-35 are two-prong eating disorder inventories measuring eating and body image attitudes and behaviors as well as underlying psychosocial distortion.
A person who scores in the lowest tertile of ecSI 2.0TM (16 or below) may exhibit eating, body image, and psychosocial attitudes and behaviors associated with eating disorders.
The higher subjects score on both the original2 and updated3 ecSI 2.0TM, the lower they score on EDI-defined indicators of both eating/weight distortion and psychosocial limitations associated with eating disorders. Subjects who score in the lowest ecSI 2.0TM tertile (16 or below)3 score within typical EDI-2 and EDI-3 clinical ranges for these indicators:
- Body dissatisfaction
- Low self-esteem
- Personal alienation (emotional emptiness and aloneness)
- Interpersonal insecurity (difficulties expressing thoughts and feelings)
- Interpersonal alienation (lack of trust in relationships)
- Maturity fears (desire to retreat to childhood)
The eating competence interview study
Cognitive interviews with low-income women7 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
- Disorganized, inattentive eating
- Distress about failure to adhere to food management rules
Hypothesis: ecSI 2.0TM helps detect eating disorders
A person who scores in the lowest tertile of ecSI 2.0TM (16 or below)3 may exhibit eating, body image, and psychosocial attitudes and behaviors associated with eating disorders. Identifying ecSI 2.0TM cutoffs that warrant exploration of eating disorder diagnosis requires further study.
- Use EDI5 or the validated but uncopyrighted EAT-268 along with ecSI 2.0TM.
- As with any other paper-and-pencil test, cautiously interpret low ecSI 2.0TM scores, even when used in conjunction with EDI and/or EAT-26, as indicating an eating disorder. Only clinical examination can determine whether the person truly has an eating disorder.
- Until the scoring norms are established by further research, accumulate your own body of knowledge about typical ecSI 2.0TM scores you observe in people with eating disorders.
- Because ecSI 2.0 has been demonstrated to have test/retest reliability,9 you may administer ecSI 2.0TM before, during, and after intervention to support evidence-based clinical practice.
- Bruch H. Eating Disorders: Obesity, Anorexia Nervosa and the Person Within. New York: Basic Books; 1973.
- 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:S154-166.
- 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.
- Stunkard AJ, Messick S. The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. Journal of Psychosomatic Research. 1985;29(1):71-83.
- Garner DM. Eating Disorders Inventory 3. Odessa, FL: Psychological Assessment Resources, Inc.; 2000.
- Garner DM. Eating Disorders Inventory 2. Odessa, FL: Psychological Assessment Resources, Inc.; 1991.
- 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. 2010;42(4):277-283.
- Garner DM, Olmsted MP, Bohr Y, Garfinkel PE. The eating attitudes test: psychometric features and clinical correlates. Psychol Med. 1982;12(4):871-878.
- Stotts JL, Lohse B. Reliability of the ecSatter Inventory as a tool to measure eating competence. J Nutr Educ Behav. 2007;39:S167-170.
ecSatter and eating disorders
- Are we teaching our children conflict and anxiety about food?
- ARFID: What is it? What does it have to do with feeding dynamics and eating competence?
- Child on psychotropic medication
- Court-ordered placement for child obesity: what can you do to help?
- Emotional eating
- Versions of internally regulated eating
- What does eating competence research say about eating disorders