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study on Eating Competence and heart disease risks: are you “eating competent?”

Posted by on Dec 22, 2010 in Blog Posts | 9 comments

A recent article in the The Journal of Nutrition (Eating competence of elderly Spanish adults is associated with a healthy diet and a favorable cardiovascular disease risk profile. May 2010) is another glimpse into the HOW of eating and the effect on health. This study on Eating Competence included almost 700 people who already had risk factors for heart disease including high blood pressure and diabetes.  (Earlier studies showing EC folks have lower BMI, diet less, have a more balanced intake, less disordered eating, and better nutrition were on healthy young adults.)

What was so exciting was the those who were ‘eating competent’ had better blood sugar measures, better levels of “good cholesterol” tended to have a lower BMI (in spite of higher energy intake– again, it’s NOT just calories in calories out) and higher adherence to the Mediterannean diet and higher fruit intake. Note, the Eating Competence (ecSatter) validated measuring tool says nothing about calorie counts or food guides. It’s essentially about HOW you eat.

I am thrilled that we are beginning to look more at the HOW in good, randomized controlled study kinds of ways. Alas, there isn’t much money to be made on helping people be competent with their eating so we don’t have hoards of Universities and researchers lined up… In fact, there is a helluva lot of money to be made off incompetent eating, from diet pills to cholesterol meds and bariatric surgery.

But, you may ask, what is “eating competence? (following is  from

Eating Competence

Eating is supposed to be enjoyable. For too many of us, eating represents trouble. We feel guilty if we eat what we ”shouldn’t” and deprived if we eat what we ”should.” We eat more than we think we should, and we worry about weight. Surveys show that when the joy goes out of eating, nutrition suffers. Roughly half of today’s consumers who know about MyPyramid, the official dietary guide, say they ”don’t really follow it.” Only 20% of consumers get their five-a-day of fruits and vegetables, and more and more people are overweight. What we are doing isn’t working. But what do we do instead? Consider the Satter Eating Competence Model (ecSatter).

ecSatter encourages you to feel positive about your eating, to be reliable about feeding yourself, to eat food you enjoy, to eat enough to feel satisfied, and to let your body weigh what it will in accordance with your lifestyle and genetic endowment. Rather than expecting you to manage your eating by the rules, ecSatter encourages you to base your eating on your body’s natural processes: hunger and the drive to survive, appetite and the need for pleasure, the social reward of sharing food and the tendency to maintain preferred and stable body weight.

You may worry that being so positive and relaxed will send your eating out of control. Not so. Being able to eat the foods you like in satisfying amounts gives your eating order and stability. Foods you no longer have to eat become enjoyable foods that you can eat for pleasure. Foods that are no longer forbidden became ordinary foods that you can eat in ordinary ways. Large portion sizes become unappealing when you know that you don’t have to try to make yourself go hungry in the name of weight control. What about your health indicators and your weight? According to research published in the fall 2007 Journal of Nutrition Education and Behavior and since, people who are eating competent do better nutritionally, have healthier body weights, and have higher HDLs and lower triglycerides and blood pressures. 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.

To become competent with your eating, emphasize 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 you eat them.

For more eating competently (and for research backing up this advice), see Ellyn Satter’s Secrets of Feeding a Healthy Family: How to Eat, How to Raise Good Eaters, How to Cook, Kelcy Press, 2008. Also see to purchase books and to review other resources.

Copyright © 2010 by Ellyn Satter. Published at

ARE YOU EATING COMPETENT? Are you teaching your child to become a competent eater? That process of learning starts at birth, and what a gift to give a child!

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  1. Kris

    The problem with this study is that it’s correlation, not causation. It doesn’t show that improving EC improves health.

    It could well be that those who eat more fruits and vegetables (for example) feel less pressure to change their diet, and so they are EC. Thin people aren’t as pushed to change their diet habits as fat people, either, which might mean that thin people are more likely to be EC. If the conventional diet message was that bacon was good and fruits and veggies were to be avoided, you might find that bacon-eating fruit-avoiders were more EC than fruit-lovers.

    • katja

      Thanks Kris,
      I think I goofed when I said we are beginning to see more randomized controlled trials, and you’re right, this was NOT an RCT.
      This was an epidemiological study so you are right there is no cause and effect studied or implied by this study. (So the problem was perhaps in my excitement about seeing this being studied and how I described it. BTW, I do believe that improving EC will improve health, and some HAES studies are beginning to show improved biomarkers regardless of weight with intervention trials…)
      In theory, the folks in this study, who have identified risks for CVD, like hypertention and diabetes are all being pressured in some way to change how they are eating for their medical conditions, but the study didn’t look at that. EC people come in all shapes, but tend to have more stable weight and tend to have lower BMI based on past studies (also Lohse) I liked that this study showed that EC people took in more total calories, but weighed less. This study didn’t look at why, could it be metabolism, combinations of food, a problem with study design? We don’t know. What we do see is that folks who feel good about eating, who provide themselves with regular and satisfying meals and eat based on internal hunger have better health parameters in these studies. That’s pretty exciting to me, and something we should take a closer look at. Do you agree?
      Again, it’s how we interpret what the study tells us based on the framework of our own experiences and our clinical experiences. I know from myself and my colleagues who do this work that anecdotally when EC improves, so does health and blood sugar and more. Now, we just need the studies that prove it!

  2. Elizabeth

    I thought you guys would be interested in this New York Times article: Nutrition: At Home, Influence Wanes on Child Diets. My question – where are these kids eating most of their meals, if their diets vary so much from their parents’?

    • katja

      I’ll have to check it out. I’m not a big fan of data-mining studies, they also mentioned only 3 of the studies were in the developed world, so if the populations studied are significantly different from yours, then the conclusions are not easily transferred. Thanks for sharing though!

  3. Patsy Nevins

    I feel a bit insulted by the suggestion that ‘eating competently’ is automatically supposed to result in a lower BMI & that that is something always to be desired, an indication of better health. I have eaten competently most of my life, & certainly for well over 30 years, since I gave up dieting for good & learned to accept my body & eat naturally, & I have never in my life eaten compulsively or binged in any way. Yet, I do NOT have a lower BMI, nor do a lot of other people I know with pretty normal eating habits. Most of my relatives, who lived well into their 80’s & 90’s, met the definition of ‘competent eating’ & most of them were fat. It seems as if the majority of people who promote non-dieting, ‘intuitive eating’, etc. believe that virtually all fat people are compulsive eating & that eating normally will result in a lower body weight. It just doesn’t for everyone, because not everyone is supposed to be slim or even just plump.

    I do, however, applaud the idea of listening to one’s own body & eating naturally, not according to ‘plans’ or ‘programs’. And, yes, you do state that eating competently is better for health than a lifetime of dieting, regardless of weight, which I do appreciate.

    • katja

      EC results in more stable BMI as well. By lower, note I am not indicating and range or label, I don’t mean “normal” or “overweight” but BMI tends to be lower, if my understanding is correct. BMI might be 4, 30 or 32 or 34, vs higher in a nonEC group. I hope I did not imply that you have to have a “normal” BMI to be healthy. Many who are not EC tend to diet and restrict, with the predictable consequence of weight gain over time. It does not result in lower BMI necessarily if you become EC. Folks who are, just tend to have lower BMI than those who aren’t. If you are not EC, and your EC improves, you might lose weight, you might not, but your health will likely improve. Does that make sense? I hope I didn’t offend and will be more careful with my wording in the future. Please let me know… Do you think you might be heavier if you were not eating competent? I suspect I would be…

      • katja

        OK, I goofed. I was in the shower thinking about this, and of course, one might weigh less or more than is healthy for one if one is not a competent eater. Chronic restraint is not competent eating, but many with disordered eating are both heavier and lighter than is healthy for them. For myself, if I had not found this model of eating, I know I would worry much more about my intake, tend to try to restrict and likely be heavier, and a LOT less happy.

  4. katja

    there are a few other articles that may also help on Eating Competence with Lohse… Might be helpful. There is an increasing body of evidence to show that EC and HAES based interventions are better for health, regardless of weight…

  5. KellyK

    That’s exciting. I’m going to have to read the whole article (and probably save it for the next time I talk to my endocrinologist, who really wants me to go on a weight-loss diet and see a nutritionist to work on choosing foods and cutting calories, while I’d really prefer to (and am going to) work with a nutritionist who uses Ellyn Satter’s methodology).


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