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November 16, 2007
Family Meals Focus #21
Interpreting the news and research about feeding and eating

The Satter Eating Competence Model (ecSatter) works. According to research published in the fall 2007 Journal of Nutrition Education and Behavior, people who have high eating competence have indicators of doing better nutritionally, have healthier body weights,¹ have higher HDLs and lower blood pressures, even when stress-tested, and have fewer of the components of ''sticky plaque,'' today's high-tech approach to predicting the tendency to cardiovascular disease.² Remarkably, they are also healthier emotionally and socially. People with high eating competence feel more effective, are more self-aware and are more trusting and comfortable both with themselves and with other people.¹

ecSatter is the result of my over 30 years' experimentation in clinical practice. In that practice, I consistently found prescriptive dietary interventions to undermine my patients' foodways, to destroy their ability to intuitively regulate food intake, to worsen their nutritional status and to spoil their attitudes about eating. Because eating is so central to life, my patients were not only demoralized about eating, they were demoralized overall. Because it was so glaringly clear to me that the harm far outweighed the benefit, I changed my ways. Rather than trying to control or subvert their natural tendencies to regularly provide themselves with ample and enjoyable food, I learned to build on those tendencies by emphasizing permission and discipline:

• The permission to choose enjoyable food and eat it in satisfying amounts.
• The discipline to have regular and reliable meals and snacks and to pay attention when eating them.³

Initially, my patients and I worried that such permission would send them out of control with their eating. In practice, being able to eat the foods they liked in satisfying amounts gave their eating order and stability. Foods that were no longer forbidden became ordinary foods that they could eat in ordinary ways. Large portion sizes become unappealing in the context of regular and reliable meals and snacks featuring adequate amounts of rewarding food.

I organized my observations into a formal model and gave it a name.⁴ My name is on the model to protect it, to keep others from giving it meanings different from what I intend. I designed a paper-and-pencil test, the ecSatter Inventory (ecSI), to assess the degree to which people possessed those positive eating attitudes and behaviors. For the last five years, Barbara Lohse, associate professor first at Kansas State University and then at Pennsylvania State University and I have collaborated to examine whether the test works to measure eating competence,it does,and to define the characteristics of competent eaters that I outlined in the first paragraph.¹

Dr. Lohse emphasizes that ecSatter represents a fundamental shift from the conventional approach to eating management. ''If it was successful to have people be uncomfortable and restrictive with what they eat, just going by the rules for the nutrients and calories they need, we would not have an obesity problem. We need a different mindset: Weight is not the big issue, but rather being comfortable with how you eat,'' she emphasized.

There are four components for ecSatter:⁴

• Context: Take time to eat, and provide yourself with rewarding meals and snacks at regular and reliable times.
• Attitude: Cultivate positive attitudes about eating and about food. Emphasize providing rather than depriving; seeking food rather than avoiding it.
• Food acceptance: Enjoy your eating, eat foods you like, and let yourself be comfortable with and relaxed about what you eat. Enjoying eating supports the natural inclination to seek variety, the keystone of healthful food selection.
• Internal regulation: Pay attention to your sensations of hunger and fullness to determine how much to eat. Go to the table hungry, eat until you feel satisfied, and then stop, knowing another meal or snack is coming soon when you can do it again.

Because it supports positive nutritional status, weight management and disease prevention,^1,2 ecSatter is to be used instead of, not in addition to prescriptive approaches to food management such as MyPyramid or DASH (Dietary Approaches to Stop Hypertension).

The following issues address the detail of eating competence: FMF #22 Eating Attitudes; FMF #23 Food Acceptance; FMF #24 Internal Regulation; FMF #25 Context Management; FMF #26 Putting it All Together.

Selected References

1. 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 Suppl. 2007;39:S154-S166.

2. Psota T, Lohse B, West S. Associations between eating competence and cardiovascular disease biomarkers . J Nutr Educ Behav Suppl. 2007; 39:S171-S178.

3. Satter EM. Nutrition Education with the Satter Eating Competence Model. J Nutr Educ Behav Suppl. 2007;39:S189-S194.

4. Satter EM. Eating Competence: Definition and evidence for the Satter Eating Competence Model. J Nutr Educ Behav Suppl. 2007;39:S142-S153.

Copyright © 2007 by Ellyn Satter. Published at www.EllynSatter.com.