An interview with nutritionist/author
Ellyn Satter, R.D., M.S.W.
By Joan Price
From Radiance Winter 1991
Nutrition expert Ellyn Satter's philosophy of child feeding is as simple
as it is radical: "The parent is responsible for what, when and where. The child is
responsible for how much and whether." That's it? Yes. Does it work? Yes, insists
Satter. She suggests that following this division of responsibility can solve most
children's eating problems-and help us understand our own.
Satter, author of Child of Mine: Feeding with Love and Good Sense,
and her latest book, How to Get Your Kid to Eat . . . But Not Too Much (both
available from Bull Publishing Company), has been a registered dietician for 25 years and
a clinical social worker for 10 years. For much of her career, she was a nutrition
counselor. But she found that nutrition information alone did not supply the solutions to
the eating problems she saw.
"I was confronted with problems that I could neither understand nor
resolve working as a dietician. I became increasingly curious about the way people's
feelings and interactions with each other impinged on their ability to manage their
eating. Emotions and food seemed so intertwined that unless I looked at all the factors, I
couldn't be helpful to people."
Satter decided to move into psychological and social counseling, with a
specialty in eating problems and disorders. Combining nutrition and psychology has led her
to look at eating problems-especially those of children-in new ways. Children need to be
trusted, not controlled or forced. If they're not overmanaged, children will eat
instinctively in a way that's right for them, using their internal cues of hunger,
appetite and sense of fullness.
"Parents are responsible for what is presented to eat and the
manner in which it is presented," repeats Satter. "Children are responsible for
how much and even whether they eat." This is the core of her message. Parents plan
the shopping list and menu and decide what food will be in the house. They determine the
structure of meals and snacks-what foods to prepare, when they will be served and where.
The child can then choose from the variety of food put on the table and decide how much of
it to eat. "Children don't eat some of everything like adults. We do it because we
paid for it or because it's good for us. But that doesn't cut any ice with children. They
eat only what pleases them on a specific day. They might eat only one or two food items,
and that's it. They might eat a lot one day and a little the next. That drives parents
nuts." But it doesn't hurt the children!
Satter traces the roots of most childhood eating problems to parents who
cross the line of this division of responsibility by trying to dictate the amount and
kinds of food their children eat. "I have parents who force their children to sit at
the table for an hour to get them to eat their vegetables. Or parents who think their
children eat too much and restrict the amount, or who think their children eat too little
and try to get them to eat more than they voluntarily will. I see parents who short-order
cook for their children, or let their children panhandle all the time." A vicious
cycle of tense mealtime battles starts up.
All kinds of eating problems may result or worsen from trying to
overrule a child's internal eating cues, says Satter. "Children who are forced,
cajoled, enticed or even tricked to eat end up revolted by food and prone to avoid eating
if they get a chance." And children whose food intake is restricted in an effort to
keep them from getting fat will become preoccupied with food. They will often tend to
overeat, fearing they won't get enough.
Satter recommends the same solution for all eating problems:
"Establish the structure of meals and snacks, and maintain a division of
responsibility in feeding. Present the food to the child, keep the pressure off, keep the
mealtime pleasant and let the child take the initiative in eating." That doesn't mean
a laissez-faire attitude toward nutrition. It's the parent's job to put wholesome,
appealing foods on the table. But don't panic if a child doesn't choose from every food
group at every meal. Over time, children will vary their selections. How to Get Your
Kid to Eat offers these facts about children's eating:
- Children will eat.
- They are capable of regulating their food intake.
- They generally react negatively to new foods but will usually accept them
with time and experience.
- Parents can either support or disrupt children's food acceptance and food
Satter is vehemently opposed to depriving fat children of food to
control their weight. She sees four ways that children become fat:
(1) Normal: "Some people are genetically predisposed to being fat."
(2) Developmental: "Someone in the child's environment is getting him or her to
overeat and doing it consistently and persistently so the child does overeat and gets
(3) Reactive: "A child who gains weight during or in reaction to a stressor, such as
(4) Fatness as a result of restrained feeding: "The tactic of withholding food from a
too-fat child can not only make her feel bad about herself; it can also make her eat
Physicians often mistakenly assume that if a child is getting fat, it
must be a result of overfeeding. "Some kids will overeat and some won't,"
insists Satter. "Some will fight to the death rather than eat one more morsel than
they really want. Other children like eating and will eat beyond satiety and not
Most adults, according to Satter, are "restrained eaters."
They chronically withhold food from themselves, trying to eat less than they really
want-less in quantity and less appealing food. They ignore and overrule their appetites.
Restrained eaters' anxiety about their ability to manage their own eating leads them to
overmanage their children's eating, imposing their own expectations on their children.
Most adults have trouble following Satter's cardinal rule: Trust that
children will eat the right amount of food to grow well. Isn't this true for adults as
well? "Indeed. We've forgotten what it's like to eat normally," Satter explains.
"Chronic dieters consistently expect themselves to go hungry and are consistently
unreliable about providing themselves with food. Nobody can be comfortable if she goes
through life expecting not to be fed."
The hazards of this behavior are both physiological and emotional.
"People deplete themselves nutritionally as they go on severe diets and don't get the
nutrients they need. Then they go on repleting binges emphasizing high- fat, high-sugar,
low-nutrient foods. And there's the whole feeling that their eating is out of control, and
therefore they are out of control. Eating becomes a moral issue." Part of her answer
to those who are parents is, "If you feed your child well, you'll find yourself
challenged to learn how to eat normally also." Like our children, we adults have an
innate ability to regulate our food intake.
Satter shares her views through her books, workshops and lectures. She
is in demand as a speaker for gatherings of health professionals, who are typically either
experts on nutrition or on mental health, but not both. To these groups Satter's views may
seem radical, and, in fact, most of her colleagues have different orientations about food
She says most health professionals focus on food selection and tend to
regulate food intake more on the basis of externals than internals. As long as the
approach to problems is based on externals, solutions are difficult.
Satter gives an example. She recently treated a child who was brought in
because she had started gaining weight rather suddenly. "I looked at the child and
the way she was being fed. I discovered that the parents were restricting her food intake,
and she was becoming preoccupied with eating. She would overeat whenever she could get the
food. We worked on that and resolved the problem to a limited extent, but it seemed like
the parents couldn't really change the way they operated. They would do some of what I
suggested, but they couldn't really turn the situation around."
This told Satter that something else was going on in the family. The
parents, she found, were so involved in their own conflicts that they could not work
together to parent the child. Their negative feelings kept them overly rigid and highly
critical of their daughter. "She was scapegoated a lot for the negative feelings they
had for each other." What started as problem solving about the little girl's eating
shifted to couple therapy for the parents' emotional problems.
Though Satter's work with adults predates her work with children, both
her books have been on children, and when she talks to groups it is most often about
children. She is developing an intensive training for health professionals and mental
health professionals to help them work with childhood eating problems. And she is planning
a book for adults on food issues.
Satter, who lives and works in Madison, Wisconsin, says she lives her
own lessons. "I struggled with my eating when I was younger and it wasn't until early
in my career that I developed a different way of eating. I experienced a lot of relief at
learning to internally regulate my food intake. I have a personal sense of how nice it is
to learn to do that."
What are her dreams for the future? "I'd like to be right here. In
deciding to become a psychotherapist, I've taken on a lifelong challenge. It's a constant
process of reading and acquiring knowledge, and of self-examination! Nutrition is
intellectually challenging. Being a therapist is personally challenging. The complexity is
mind-boggling! I'm having such a good time now. I can't even dream of anything
A Radiance subscriber, Satter
supports Radiance's philosophy of emotional
health and self-acceptance. "In this whole area of eating and weight management,
there are very few Cinderella stories. My best advice is to live your life as if you're
going to be the weight you are right now, and simply go ahead and do what you want to do.
The messages I read in Radiance couldn't be more
JOAN PRICE is a widely published freelance health and fitness writer
and a frequent contributor to Radiance. http://fitnesslink.com/joanprice/
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