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An all too typical first meeting with a new client struggling with eating, weight and with their relationship with food goes something like this, “I have issues and I’m so hoping you can help me. I’ve been trying to lose weight on and off for as long as I can remember, and I just can’t seem to get anywhere anymore. I used to be able to at least lose weight and maintain it for a while, but now, I can’t even put together one day of good eating. I try to stay positive thinking tomorrow is a new day, I’ll do better tomorrow…tomorrow never comes.”

The client wants desperately for something to change, but they have no idea what that would look like. The only option is to return to the cycle of deprivation followed by a loss of control, what’s commonly referred to as yo-yo dieting. After exploring the client’s history of eating and weight, a skilled clinician can identify them as a Dieting Casualty – a term coined by Ellyn Satter, used to describe someone who has been on the dieting roller coaster, characterized by highs and lows of restraint and disinhibition. No longer able to sustain caloric restriction, or trust their internal compass for hunger and fullness, eating is chaotic, and weight is unstable. Yet still, food remains the focus of attention as if the answer can be found there.

Messages are everywhere that reinforce the diet/binge cycle. That roller coaster does the opposite of building trust in our abilities to eat competently, and it erodes self-efficacy – our belief in our own ability to navigate our way through the world.  Just look at magazine covers in the checkout line- pictures of decadent food next to headlines of how to lose weight.  Also, the increase in health care based bariatric centers that normalize dieting behaviors, symptoms and side effects.  The universal response to a failed diet is to recommend repeating the program(s) over and over.


Doing the same thing over and over and expecting different results.

-Albert Einstein

Do things differently and expect different results.

Eating Competence, Satter’s term used to describe normal eating, provides a framework to understand what normal eating is for each of us. Eating Competence is not about controlling our weight; it is about learning to trust our ability to care of ourselves with food.  Those who test eating competent do better nutritionally, emotionally and biometrically.  Interestingly, the focus remains with “how” we feed ourselves and the “what” follows more naturally within this trust-based model. 

Eating Competence is comprised of four distinct areas:

  • Positive Attitudes and Beliefs about food and about eating – competent eaters are relaxed about food and eating. They look forward to eating and enjoy their food. They aren’t anxious about it, they aren’t preoccupied by it, and they don’t obsess after they have eaten it. They eat and then they move on.
  • Food Acceptance Skills – competent eaters like a variety of food and enjoy trying new foods and learning to like them…or not. They can “make do” in situations that call for it, eating food they don’t much care for because not every meal has to be the most exciting.
  • Internal Regulation Skills – competent eaters tune in to their bodies when they eat. They know when they are hungry and when they are not. They trust those hunger and fullness cues enough to decide to keep eating to stop because they are truly satisfied.
  • Context Management – competent eaters plan for feeding themselves. They are reliable and can depend on themselves to have regular meals and snacks in between if they want/need them.

Developing eating competence is a process. Some do well on their own, others do not and need support from a skilled clinician, one who is able to think about things differently.

Those who are trained in Ellyn Satter’s Eating Competence model find the possibilities to be endless and applications go well beyond treating the dieting casualty.  It provides clarity for the clinician and paves the way for care planning. 

If you are interested in expanding your skills and be able to provide Satter informed care for your patients, join us for our VISIONS workshop: Treating the Dieting Casualty, in Madison, WI.  November 14, 15 &16 2019.  TDC workshop registration

Keira Oseroff, MSW, LCSW and Jennifer Harris, RDN, LD, CEDRD: Ellyn Satter Institute Faculty members.

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