July 19, 2007
FAMILY MEALS FOCUS #18
Interpreting the news and research about feeding and eating

Family Meals Focus #15, #16 and #17 addressed what doesn't work with respect to eating management during pregnancy. Now let's talk about an approach that is likely to work - or at least, do no harm. To tell you what I would like to see happen to support positive eating management during pregnancy, this issue gives you a sneak peek at embargoed work on the Satter Eating Competence Model (ecSatter). That work will be published in a supplement to the fall Journal of Nutrition Education and Behavior¹ and demonstrated in the 2008 revised edition of Secrets of Feeding a Healthy Family. ecSatter stresses providing rather than depriving, food seeking rather than food avoidance. Eating for Pregnancy demonstrates an ecSatter-consistent handout. According to the ecSatter Inventory, a validated paper-and-pencil questionnaire, people who have high eating competence do well nutritionally and maintain weights close to the mean.²

ecSatter and Eating for Pregnancy support the pregnant woman in being nurturing and trusting with feeding herself and gaining weight in her own distinctive pattern. The primary nutrition goal of ecSatter is structure and the primary intervention is meal planning. Within the context of structure, energy intake is managed by attending to internal regulators of hunger, appetite and satiety. Optimal weight gain is unique for each woman and is that which results from reliable, intrinsically regulated and self-trusting nutritional care. Here is how the ecSatter model would translate into practical guidelines for nutrition counseling during pregnancy:

Encourage each woman to be positive and reliable about taking care of herself with food. Emphasize three meals a day and as many snacks as necessary to feel comfortable and energetic. Rather than emphasizing formulas, portion sizes and patterns, encourage choosing preferred food at regular eating times. Satisfying basic needs for familiar and preferred food supports mastery with an increasing variety of foods, including those that are chosen primarily for their nutritional value.³

Emphasize pleasure as a guiding principle in food selection. Endorse foods that the individual herself finds enjoyable. To support the day-in-day-out demands of maintaining regular meals and snacks, food must be richly rewarding to plan, prepare, provide and eat.⁴

Teach and support internal regulation of food intake. Encourage going to the table hungry but not famished, paying attention to and enjoying eating, and eating until hunger and appetite are satisfied. Reassure the pregnant woman that she will stop, knowing another meal or snack is coming soon when she can do it all over again. Given reliable access to food and attention to eating, internal cues of hunger, appetite and satiety become more prominent and reliable.

Teach and model body trust. Support each woman in discovering and trusting her body's unique wisdom by cultivating an attitude of curiosity and acceptance about month-to-month and overall patterns of food behavior and weight gain. Hunger and appetite vary from one woman to another, from month to month, and among the first, second and third trimesters. As long as the woman reliably provides herself with appealing food at predictable times and attends to internal cues, she is likely to do well nutritionally and gain weight in a way that is right for her.

Evidence supporting ecSatter during pregnancy
Most critically, ecSatter does no harm. It supports positive attitudes about eating and body weight, intrinsic processes of food and body weight regulation and corrects destructive attitudes and behaviors with respect to food management and body weight regulation. ecSatter is based on trust in the individual to act on her own behalf. Such trust is supported by the research literature:

• Women who consume an optimal meal pattern of three meals and two or more snacks have the lowest rates of preterm births. Women who eat erratically have a 30 percent higher risk of preterm delivery.⁵ Based on relative Healthy Eating Index scores, pregnant women do better with food selection than non-pregnant women.⁶
• Pregnant women are relatively receptive to an eating competence approach: Compared with the months prior to their pregnancy, pregnant women rated themselves as less dissatisfied with their body shape, less driven to pursue weight restriction and less restrained in their eating behavior.⁷ Women vote with their feet. 38% of black and 18% of white women refused to participate in obstetrical weight management programs.⁸

If I Had a Dream,
I would make nutrition counseling available to all prospective parents, helping them to establish family meals, learn competent eating and develop positive approaches to food management that are likely to persist after the baby arrives. I have done such counseling with lots of parents-in-waiting, and have found them to be delightful in their commitment to eating well for their babies. They most often come in doubting that they are eating well and go out recognizing their own positive food management practices. We almost always do a bit of tweaking, but it is limited, both because little change is necessary and because it isn't practical or kind to do major surgery on someone's approach to eating.

This is the end of our four-part series on nutrition and weight management during pregnancy. Family Meal Focus #19 addresses the issue of infant birth weight and lifetime health patterns.

Reference List

1. Satter EM. Eating Competence: Definition and evidence for the Satter Eating Competence Model. J Nutr Educ Behav Suppl. 2007;39:xxx-xxx (pages available at publication).

2. Lohse B. Measuring Eating Competence: psychometric properties and validation of the ecSatter Inventory. J Nutr Educ Behav Suppl. 2007; 39:xxx-xxx (pages available at publication).

3. Satter EM. Satter's Hierarchy of Food Needs . J Nutr Educ Behav Suppl. 2007;39:xxx-xxx(pages available at publication).

4. Satter EM; Chapter 1, The secret in a nutshell. Secrets of Feeding a Healthy Family. Madison, WI: Kelcy Press; In Press, 2008: 2-14.

5. Siega-Riz AM, Herrmann T, Savitz DA, Thorp J. The frequency of eating during pregnancy and its effect on preterm delivery. Am J Epidemiol. 2001;153:647-652.

6. Pick ME, Edwards M, Moreau D, Ryan EA. Assessment of diet quality in pregnant women using the Healthy Eating Index. J Am Diet Assoc. 2005;105:240-246.

7. Clark M, Ogden J. The impact of pregnancy on eating behaviour and aspects of weight concern. Int J Obes Relat Metab Disord. 1999;23:18-24.

8. Polley BA, Wing RR, Sims CJ. Randomized controlled trial to prevent excessive weight gain in pregnant women. Int J Obes Relat Metab Disord. 2002;26:1494-502.

Family Meals Focus by Ellyn Satter, MS, RD, LCSW, BCD. discusses trends, research and clinical issues in eating and feeding and interprets other research from a feeding-dynamics, eating-competence perspective. For past issues of Family Meals Focus, click here.

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DISCLAIMER: The information contained in Family Meals Focus is intended to inform our readers about issues relating to feeding dynamics in general and family meals in particular. It is not intended to replace specific advice from a health care professional. Copyright © 2006 Ellyn Satter