RESEARCH ARTICLE
Measuring Eating Competence: Psychometric Properties
and Validity of the ecSatter Inventory
Barbara Lohse, PhD, RD1; Ellyn Satter, MS, RD, LCSW, BCD2;
Tanya Horacek, PhD, RD3; Tesfayi Gebreselassie, PhD4;
Mary Jane Oakland, PhD, RD5
ABSTRACT
Objective: Assess validity of the ecSatter Inventory (ecSI) to measure eating competence (EC).
Design: Concurrent administration of ecSI with validated measures of eating behaviors using
on-line and paper-pencil formats.
Setting: The on-line survey was completed by 370 participants; 462 completed the paper version.
Participants: Participants included 863 adults with 832 usable surveys from respondents (mean age 36.2
⫾ 13.4 years) without eating disorders, mostly female, white, educated, overweight, physically active, and
food secure. Of those indicating intent to complete the on-line survey, 80.3% did so; 54% of mailed
surveys were returned.
Variables Measured: Eating and food behaviors compared among EC tertiles and between dichotomous EC categories; internal consistency of ecSI.
Analysis: Analysis of variance, independent t tests, chi-square, factor analysis, logistic regression.
Significance level was P ⬍ .05.
Results: Mean ecSI score was 31.1 ⫾ 7.5. ecSI included 4 subscales with internal reliability and
content validity. Construct validity was supported by specific behavioral profiles for ecSI tertiles and
ecSI dichotomized categories. Persons unsatisfied with weight were 54% less likely to be EC; unit
increase in the food like index was associated with nearly 3 times greater likelihood of being EC.
Conclusions and Implications: The ecSatter Inventory is a valid measure of EC and can be used
for descriptive and outcome measurements.
Key Words: eating competence, food behavior, weight, dietary assessment, validity
(J Nutr Educ Behav. 2007;39:S154-S166)
INTRODUCTION
1
The Pennsylvania State University, University Park, Pennsylvania
Ellyn Satter Associates, Madison, Wisconsin
3
Syracuse University, Syracuse, New York
4
ORC Macro International, Calverton, Maryland
5
Iowa State University, Ames, Iowa
Barbara Lohse was in the Department of Human Nutrition at Kansas State University
for part of the study, and Tesfayi Gebreselassie contributed to the study while
affiliated with The Pennsylvania State University.
The lead author of this article (Lohse) is also the Guest Editor for this issue, and is
on the JNEB staff as Associate Editor, Research, Reports, and GEMs. Review of this
article was handled, exclusively, by the Editor-in-Chief to minimize conflict of
interest.
Funding was provided by The Sunflower Foundation, Topeka, Kansas, and the Family
Nutrition Program of Kansas State University with funding from USDA’s Food
Stamp Nutrition Education Program.
2
Address for correspondence: Barbara Lohse, PhD, RD, 135 East Nittany Avenue,
Suite 405, State College, PA 16801; Phone: (814) 865-5169; E-mail: [email protected]
PUBLISHED BY ELSEVIER INC. ON BEHALF OF THE SOCIETY FOR
NUTRITION EDUCATION
doi: 10.1016/j.jneb.2007.04.371
The Satter Eating Competence Model (ecSatter) is a behavioral and attitudinal conceptualization of eating characterized by comfort and flexibility with eating, at the same
time as being “ matter-of-fact and reliable about getting
enough to eat of enjoyable and nourishing food.”1 In addition to positive attitudes toward food, eating competence
(EC), as defined by ecSatter, may impact weight status
because competent eaters have internal regulation skills
compatible with weight maintenance but not at the expense of energy and stamina.1 Guidelines for operationalizing ecSatter were issued in tandem with the ecSatter
Inventory (ecSI), a descriptive measure of EC, to assess
interventions that purport to promote EC concepts.2 ecSI
consists of 16 statements; respondents denote level of item
agreement as always, often, sometimes, rarely,or never
(Scored as 3, 2, 1, 0, and 0, respectively, and summed so
Journal of Nutrition Education and Behavior ● Volume 39, Number 5S, September/October 2007
that possible scores range from 0 to 48); scoring follows the
rationale of Garner.3
Based on clinical experience, ecSI items emerged from
repeated observations of typical distortions in eating attitudes and behaviors and the resolution of those distortions
by instituting their antithesis. The 16 items of ecSI examine 4 dimensions: attitudes toward eating; internal regulation (ie, the experiential processes of hunger, appetite, and
satiety); food acceptance to denote cognitive and behavioral processes and external influences of learning to like
new food; and contextual skills to reflect cognitive and
external behaviors related to managing the patterns and
opportunities for food ingestion. ecSI subscale names and
composition appear in Table 1. Five items address attitude
toward eating and 3 items encompass behaviors that support effective internal regulation. Competent eaters are
portrayed as being positive and comfortable with eating and
making sure they get enough to eat of food they find
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enjoyable. Competent eaters enjoy eating, but more to the
point, they feel comfortable with that enjoyment and with
eating as much as they want.
Three ecSI items describe capability with food acceptance, which is the antithesis of adult picky eating. ecSI
makes no attempt to assess food selection and nutritional
content of the diet, but it focuses on food-related attitudes
and behaviors. Processes involved in managing the food
context with emphasis on intentionality, structure, and
order are addressed in the final 5 ecSI statements. These
statements grew out of working clinically with compulsive
eaters, who typically try to have austere, low-calorie meals,
then sooner or later resort to hectic overeating, particularly
of restricted food.
ecSI has been peer reviewed for face validity, tested
and revised repeatedly in a clinical setting, piloted extensively in professional seminars, and shown to have
test-retest reliability.4 The purpose of this study was to
Table 1. Factor Analyses of ecSatter Inventory*
ecSatter Inventory Subscale Items
Eating Attitudes
I am relaxed about eating.
I am comfortable about eating enough.
I enjoy food and eating.
I am comfortable with my enjoyment of food and eating.
I feel it is okay to eat food that I like.
Food Acceptance
I experiment with new food and learn to like it.
If the situation demands, I can “make do” by eating food
I don’t much care for.
I eat a wide variety of food.
Internal Regulation
I assume I will get enough to eat.
I eat as much as I am hungry for.
I eat until I feel satisfied.
Contextual Skills
I tune in to food and pay attention to myself when I eat.
I make time to eat.
I have regular meals.
I think about nutrition when I choose what I eat.
I generally plan for feeding myself. I don’t just grab food
when I get hungry.
Exploratory
Factor Analysis†,‡
Cronbach ␣ .84储
0.85
0.72
0.63
0.84
0.63
Cronbach ␣ 0.65#
0.81
0.69
Confirmatory
Factor Analysis§
Cronbach ␣ .82¶
0.81
0.73
0.51
0.82
0.73
Cronbach ␣ .70**
0.80
0.76
0.68
Cronbach ␣ .75††
0.68
0.77
0.76
Cronbach ␣ .74§§
0.56
0.63
0.70
0.74
0.73
0.64
Cronbach ␣ .71‡‡
0.48
0.85
0.81
Cronbach ␣ .79储储
0.51
0.74
0.81
0.70
0.74
*Principal Components Analysis, Varimax Rotation with Kaiser Normalization, table entries are factor loadings.
†
Mean age 20.4 ⫾ 3.1 years, mean ecSatter Inventory score 29.4 ⫾ 7.5, 29.9% male; see reference 11.
‡
N ⫽ 807, 4 factors explain 60.2% of variance, Cronbach ␣ 0.84; see reference 11.
§
N ⫽ 832, 4 factors explain 60.5% of variance, Cronbach ␣ 0.85
储
Eigenvalue 3.2, factor explains 19.8% of variance
¶
Eigenvalue 3.0, factor explains 18.8% of variance
#
Eigenvalue 1.8, factor explains 11.1% of variance
**Eigenvalue 2.0, factor explains 12.3% of variance
††
Eigenvalue 2.3, factor explains 14.1% of variance
‡‡
Eigenvalue 2.0, factor explains 12.4% of variance
§§
Eigenvalue 2.4, factor explains 15.1% of variance
储储
Eigenvalue 2.7, factor explains 17.03% of variance
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Lohse et al/MEASURING EATING COMPETENCE
examine ecSI psychometric properties and assess ecSI
construct validity.
METHODS
Construct validity was examined by comparing ecSI responses with those from pretested, valid, and conceptually
congruent instruments administered simultaneously as a
self-report survey booklet completed either on-line or with
paper-pencil. Placing ecSI either first or last in the booklet
with random booklet assignment controlled for an order
effect of completion.
Data Collection
Eligibility requirements were age 18 years and older; literate
in English; not pregnant, lactating, or dependent on homedelivered meals for nutrition; and without specified health
issues that would affect dietary behavior (diabetes; need for
renal dialysis, total parenteral nutrition, or tube feeding;
diagnosis of cancer, heart, liver, or lung disease in the past
5 years; prior surgery for weight loss). Participation incentive was entry into a drawing for two $75 awards on survey
completion. Drawing entry forms were separated to maintain response anonymity.
Paper surveys. Eight hundred fifty-six spiral-bound,
16-page paper surveys were mailed or hand delivered and
returned by either intercampus mail, a stamped, addressed
return envelope, or a conveniently placed drop box; 462
(54%) surveys were returned. Participants were recruited
from various worksites such as banks, elementary and high
schools, and university offices in multiple states. Researchers used civic and service group contacts as well as a listing
of associates in the Ellyn Satter Institute to recruit members
into the study.
On-line delivery. Survey booklet content was converted to a Web-based survey and administered using Kansas State University’s Survey System. Recruitment used an
informational e-mail to summer-school students and employee listservs from 2 universities (Kansas and Iowa State
Universities) and a state and a city government. Respondents to the e-mail completed an eligibility screener, then
they were directed to the on-line survey; completion was
required at the time the survey was initiated. From more
than 3000 recruitment e-mails, 461 responses were received; of these responses, 388 (84.2%) accessed and 370
(80.3%) completed the survey. On-line and paper surveys
both required approximately 30 minutes to complete. Online and paper data collection methods were pilot-tested
with 32 and 15 subjects, respectively. Outcomes paralleled
larger study findings,5 thus these 47 surveys were included
in the study.
Surveys
Included in the survey booklets were the ecSI; the ThreeFactor Eating Questionnaire (TFEQ)6; the Eating Disorders
Inventory-23 (EDI-2); a Food Preference Survey7; a fruit
and vegetable Stage of Change algorithm8; Expanded Food
and Nutrition Education Program questions9; self-reported
height and weight; and questions about food preparation
practices, physical activity, and demographics.
Three-factor eating questionnaire. The 51-item
TFEQ is validated to measure cognitive restraint, disinhibition, and hunger dimensions of eating behavior.6 This
survey includes 15 Likert-scaled and 36 true/false items.
Eating disorders inventory-2. A meaure of symptoms commonly associated with anorexia nervosa and bulimia, this validated self-report consists of 11 subscales
derived from 91 items using a 6-point Likert scale.3 Drive
for thinness, bulimia, and body dissatisfaction are 3 subscales that measure attitudes and behaviors concerning
eating, weight, and shape, specifically fear of fatness, thinking about and practicing bingeing, and dissatisfaction with
overall shape, respectively. Five subscales (Ineffectiveness,
Perfection, Interpersonal Distrust, Interoceptive Awareness, and Maturity Fears) assess psychological traits associated with eating disorders, ie, feelings of insecurity or
worthlessness, importance of superior personal achievements, feelings of alienation or reluctance to express
thoughts, apprehension in responding to emotions, and
desire for childhood, respectively. Multidimensional aspects
of disordered eating are conveyed through 3 more subscales:
Aceticism (self-discipline or denial), Impulse Regulation
(tendency toward impulsivity and self-destructiveness), and
Social Insecurity (negativism and insecurity toward social
relationships).
Food preference survey. To gauge food selection
and intake, food preference assessment has been shown to
be an alternative to food frequency surveys.7,10 Food preference with a 62-item, 9-point spread semantic differential
scale anchored by dislike extremely and like extremely with
separate choices for never tried or would not try.
Fruit and vegetable stage of change algorithm.
Stages of change (ie, precontemplation, contemplation,
preparation, action, and maintenance) for fruit and vegetable intakes were measured separately with a validated,
2-step algorithm.8 Respondents were asked to select from a
range of choices to indicate current intake and intentions
to change intake.
Expanded Food and Nutrition Education Program (EFNEP) questions. The EFNEP Evaluation
and Reporting System (ESR4), a valid, reliable, and care-
Journal of Nutrition Education and Behavior ● Volume 39, Number 5S, September/October 2007
fully tested system, was the source for 22 questions focused
on food resource management, related food preparation
practices, and health locus of control. This section included
the base Behavior Checklist as well as state-specific items;
16 items were answered using a 5-point Likert scale; remaining items had 3 possible responses.9
Demographic, health, and food preparation
items. A 24-item, checklist-style component included
typical demographic items as well as questions related to
food preparation habits, nutrition education experience,
height and weight, weight satisfaction, and health practices
(eg, smoking, dietary restrictions, physical activity). Items
were pretested for comprehension and included in the
exploratory study of the scale’s internal consistency.11
Data Analysis
Data were analyzed with the Statistical Package for Social
Scientists version 13.0 (SPSS, Chicago, IL). P values less
than .05 were considered statistically significant. ecSI
scores were divided into tertiles and also dichotomized as
eating competent (ⱖ 32) or not, a cutoff derived from
researcher (ES) clinical psychological expertise. Tertile
profiles were developed using analysis of variance, multiple
comparison test using Scheffe’s method, and chi-square.
Dichotomized ecSI scores were compared for demographics
and cognitive and dietary behaviors using t test and chisquare analyses. Eating disorders inventory-2 raw scores
were calculated and converted to percentile ranks (using
nonpatient tables), as described by Garner.3 Beverage preferences (eg, coffee with milk or coffee with sugar) were not
pertinent to this study and therefore removed from food
listed on the food preference survey, a 9-point Likert scale.
Preference responses for the remaining 62 food items were
dichotomized into like (ⱖ 5) and dislike (⬍ 5) categories.
Discriminating preference patterns were achieved by summing preference scores for like and dislike categories and
dividing each by the number of food items in each category
to create like and dislike indices. For example, a response of
5 for all 62 food items provides a score (310) similar to a
response of 9 for 27 food items and 2 for 35 food items
(313), yet 2 profiles are clearly apparent with Like and
Dislike indices (5 and 0 vs. 9 and 2). Preference scores for
disliked foods were reversed to compute the dislike index
enabling unidirectional interpretation of both indices.
Demographic and behavioral variables were compared
with Pearson correlation coefficients. ecSI subscales were
derived from factor analysis with principal components
extraction and varimax rotation. Logistic regression using
the maximum likelihood method was used to assess the
relationship between binary EC categories and constructbased cognitive behaviors or characteristics. An ordinal
logistic regression model was used to predict EC tertile
rank. See Blitstein for an explanation of interpreting logistic regression analyses for nutrition education.12 This re-
S157
search and informed consent were approved by the affiliated university Institutional Review Boards for the
protection of human subjects.
RESULTS
Respondents
For 863 respondents, 33 states were represented, with 687
of the responses from 4 states (Kansas, New York, Iowa, and
Wisconsin); 4 respondents were Canadian. Of the respondents, 316 were students; one fourth were freshmen, one
fourth graduate students, and the remaining half equally
divided among the 3 remaining years. Students represented
several majors from disparate academic disciplines, for example, business, art, languages, science, psychology, fashion
design, early childhood education, and social work. Occupations for non-student respondents were diverse, ranging
from accountant to homemaker to educator to real estate
agent. Manufacturing, manual labor, or heavy labor sectors
were not strongly represented. As a group, respondents were
mostly female (78.7%), white, educated, overweight, physically active (66.4%), in maintenance stage of change for
both fruit and vegetable intake, generally preferring many
food items and disliking few, not food insecure, and without
disordered eating. Demographic characteristics and cognitive and behavioral descriptions are provided in Tables 2
and 3, respectively.
Survey booklets with substantial responses missing were
noted for 28 people, however 13 of these noncompleters
responded to the ecSI and other variables of interest. Their
data were included because noncompleters were not significantly different from completers by method of completion,
demographic characteristics, or any variables featured in
Table 4. The ecSatter Inventory scores did not differ according to method of survey completion (on-line versus
hard copy; 31.0 ⫾ 7.2 vs. 31.2 ⫾ 7.8; N ⫽ 370, 462,
respectively) or placement in the survey booklet (front or
back; 31.0 ⫾ 7.4 vs. 31.2 ⫾ 7.6; N ⫽ 443, 389,
respectively).
Data Fidelity
Despite the 16-page or multiple-screen survey, participants
appeared to respond consistently to questions throughout
the survey set. For example, a direct question about weight
dissatisfaction in the demographic section correlated with
EDI-2 Body Dissatisfaction (r ⫽ 0.67, P ⬍ .001; N ⫽ 683)
and EDI-2 Drive for Thinness scores (r ⫽ 0.31, P ⬍ .001;
N ⫽ 724). Scores on the TFEQ Restraint subscale were
significantly (t ⫽ 11.13, P ⬍ .001) higher for those reporting self-imposed dietary restrictions (mean 11.13 ⫾ 4.9; N
⫽ 306 vs. 7.54 ⫾ 45; N ⫽ 446), including specifically
restricting either fat, cholesterol, sugar, or sodium (t ⫽
9.77, P ⬍ .001, mean 11.09 ⫾ 4.7, N ⫽ 296 vs. 7.65 ⫾
4.75; N ⫽ 456). Scores on the EDI-2 Drive for Thinness
subscale correlated with TFEQ Restraint subscale scores (r
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Lohse et al/MEASURING EATING COMPETENCE
Table 2. Study Participants Described: Background and Lifestyle Factors*
Age (N ⫽ 819, Range 18-71 y)
Female (N ⫽ 644)
Male (N ⫽ 174)
Body mass index (N ⫽ 803)
Female (N ⫽ 631)
Male (N ⫽ 172)
Weight satisfaction (N ⫽ 820; 1 ⫽ very satisfied, 5 ⫽ very unsatisfied)
Female (N ⫽ 646 )
Male (N ⫽ 174)
Worry about money for food (N ⫽ 821; 1 ⫽ always, 5 ⫽ never)
Female (N ⫽ 647)
Male (N ⫽ 174)
Frequency of food preparation (N ⫽ 821 ; 1 ⫽ do not prepare, 2 ⫽
1 to 3 times/week, 3 ⫽ 4 to 6 times/week, 4 ⫽ every day)
Female (N ⫽ 646)
Male (N ⫽ 174)
Daily time spent preparing meals (N ⫽ 821; 1 ⫽ do not prepare, 2
⫽ less than 15 minutes, 3 ⫽ 16 to 45 minutes, 4 ⫽ more than
45 minutes)
Female (N⫽646)
Male (N⫽174)
Routinely participates in (group or individual) physical activities
Education
Some high school
High school diploma
Some college
Technical/business school
College degree
Graduate professional degree
Ethnicity
Alaska Native or American Indian
Asian
Black or African American
White
Other
Reports being a parent
Smokes cigarettes
Drinks alcoholic beverages
Received nutrition education in the past 6 months
Mean ⴞ Standard Deviation/Median
36.2 ⫾ 13.4/36
36.2 ⫾ 13.4/37
36.2 ⫾ 13.5/34
26.0 ⫾ 5.9/24.4
25.7 ⫾ 6.1/24
27.0 ⫾ 4.9/26.3
3.2 ⫾ 1.2/3.0
3.3 ⫾ 1.2/4.0
2.9 ⫾ 1.1/3.0
4.2 ⫾ .97/4.0
4.2 ⫾ .93/4.0
4.1 ⫾ 1.1/4.0
3.0 ⫾ 1.0/3.0
3.1 ⫾ 1.0/3.0
2.8 ⫾ 1.0/3.0
2.7 ⫾ 0.7/3.0
2.8 ⫾ 0.7/3.0
2.6 ⫾ 0.8/3.0
Frequency (%)
513 (61.7)
4 (0.5)
51 (6.2)
263 (32.1)
53 (6.5)
236 (28.8)
214 (26.0)
7 (0.9)
19 (2.5)
22 (2.9)
705 (92.2)
12 (1.6)
405 (49.6%)
89 (10.9%)
529 (64.9%)
552 (67.2%)
*Numbers vary due to incomplete response.
⫽ 0.24, P ⬍ .001, N ⫽ 663). Responses to a question
directly referencing worry about having enough money for
food correlated (r ⫽ 0.40, P ⬍ .001; N ⫽ 813) with an
EFNEP item about frequency of running out of food before
the end of the month.
Eating Competence Profiles
Contrasts in cognitive, behavioral, and health-related
characteristics between eating competent and not eating
competent (ecSI score ⬍ 32) respondents and among
high, medium, and low ecSI scores revealed a distinct
eating competent profile (Table 5). Eating-competent
persons (ie, ecSI score ⱖ 32) were older; reported lower
BMI and incidence of overweight; were less dissatisfied
with weight, more physically active, and less likely to
worry about money for food; practiced better food resource management; were more likely to cook from
scratch; were more likely to be in a postaction Stage of
Change for both fruit and vegetable intake; noted fewer
Journal of Nutrition Education and Behavior ● Volume 39, Number 5S, September/October 2007
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Table 3. Eating Competence and Other Cognitive and Behavioral Descriptors
Mean ⴞ SD/Median; Possible Range
31.1 ⫾ 7.5/31.0; 0 to 48
11.1 ⫾ 3.0/11.0; 0 to 15
8.5 ⫾ 3.3/9.0; 0 to 15
4.9 ⫾ 2.2/5.0; 0 to 9
6.7 ⫾ 1.8/7.0; 0 to 9
Mean ⴞ SD/Median; Possible Range
9.0 ⫾ 5.0/9.0; 0 to 21
6.6 ⫾ 4.0/4.0; 0 to 16
5.4 ⫾ 3.4/5.0; 0 to 14
Percentiles ⴞ SD/Median Percentile
50.6 ⫾ 20.8/55
62.0 ⫾ 14.3/50
52.4 ⫾ 26.1/51
60.3 ⫾ 15.3/55
50.2 ⫾ 27.6/46
52.6 ⫾ 19.3/54
55.6 ⫾ 17.8/57
57.5 ⫾ 23.9/54
51.3 ⫾ 25.9/57
52.1 ⫾ 16.2/41
48.2 ⫾ 25.8/51
Mean ⴞ SD/Median
51.7 ⫾ 7.8/53
8.6 ⫾ 6.3/7
2.4 ⫾ 3.7/1
7.6 ⫾ 0.5/7.6
2.4 ⫾ 0.8/2.4
Eating Competence (Nⴝ832)
Total Score
Eating Attitudes
Contextual Skills
Food Acceptance
Internal Regulation
Three Factor Eating Questionnaire
Restraint Scale (N⫽757)
Disinhibition Scale (N⫽801)
Hunger Scale (N⫽795)
Eating Disorder Inventory-2
Drive for thinness (N⫽725)
Bulimia (N⫽762)
Body Dissatisfaction (N⫽684)
Ineffectiveness (N⫽736)
Perfectionism (N⫽808)
Interpersonal Distrust (N⫽761)
Lack of Interoceptive Awareness (N⫽750)
Maturity Fears (N⫽778)
Asceticism (N⫽799)
Impulse Regulation (N⫽786)
Social Insecurity (N⫽774)
Food Preference*
Number of foods liked (N⫽832)
Number of foods disliked (N⫽832)
Number of foods never tried (832)
Food Like Index (N⫽830)†
Food Dislike Index (N⫽783)‡
Stage of Change:
Fruit (N⫽824)
Vegetables (N⫽822)
Precontemplation
119
160
Contemplation
68
80
Food Resource Attitudes and Practices N (%)
How often do you . . .
feel confident about managing your money to make healthy
food available to you?
use a written spending plan or budget for food?
shop with a grocery list?
plan meals ahead of time?
run out of food before the end of the month?
Preparation
158
128
Action
49
26
Maintenance
430
428
Never/Seldom
229 (28)
Sometimes
163 (20)
Mostly/Always
424 (52)
581 (71.1)
134 (16.4)
181 (22.2)
517 (63.4)
121 (14.8)
156 (19.1)
326 (40.0)
163 (20)
115 (14.1)
527 (64.5)
309 (37.9)
135 (16.6)
*For the 62 food items, responses from 1 (Dislike extremely) to 4 denoted dislike. Responses from 5 to 9 (Like extremely) represented liking the item.
†
Food Like Index ⫽ Preference Score of foods liked divided by number of foods liked. Possible range 5 through 9; higher score denotes greater preference.
‡
Food Dislike Index ⫽ Preference Score of foods disliked divided by number of foods disliked. Possible range 1 through 4; higher score denotes greater
dislike.
food dislikes and greater food acceptance; exhibited
lower feelings of cognitive restraint, disinhibition, and
hunger; and showed a lower expression of food, weight
management, and psychosocial characteristics related to
disordered eating. Scores on the ecSatter Inventory arranged among high, medium, and low tertiles showed a
gradient change in all characteristics. Striking similari-
ties were noted in these characteristics between respondents in the highest tertile and those found in the
eating-competent group as well as between respondents
in the lowest tertile and those not considered eating
competent. Post hoc analyses revealed differences to be
mostly among all 3 tertiles or between the lowest and
highest tertiles.
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Lohse et al/MEASURING EATING COMPETENCE
Table 4. Validation of ecSatter Inventory Subscales†
Subscale
Eating Attitudes
TFEQ scale:
Disinhibition‡**
Cognitive restraint‡**
EDI-2 subscale (percentile)
Ascetism**
Body dissatisfaction**
Interpersonal distrust**
Impulsivity**
Ineffectiveness**
Maturity fears**
Social insecurity**
Drive for thinness**
Food Acceptance§
Total preference score储,**
Number of foods liked**
Number of foods disliked**
Food like index#
Food dislike index††,‡‡,**
Number foods never tried**
Post-action stage of change:
Veg.§§,**
Fruit§§,**
Internal Regulation
EDI-2 Subscale (percentile):
Lack of Interoceptive awareness**
Bulimia*
Worry of money for food储储,*
No food by month’s end¶¶,**
TFEQ scale: Hunger‡,*
Self-imposed diet restrict##,*
Contextual Skills
Plan meals ahead of time***,**
Include all food groups in meals***,**
Use Nutrition Facts label***,**
Eats out of the home***,**
Successfully cooks from scratch***,**
Food prep at home ⬎3 times/week†††,**
Meal prep time ⬎15 min‡‡‡,*
Likes to cook§§§,*
High Tertile
Middle Tertile
Low Tertile
4.9 ⫾ 3.5a; N⫽291
7.3 ⫾ 4.7a; N⫽273
6.6 ⫾ 3.7b; N⫽279
9.2 ⫾ 4.8b; N⫽271
8.7 ⫾ 3.9c; N⫽231
10.9 ⫾ 4.9c; N⫽213
46.0 ⫾ 25.4a;N⫽291
43.1 ⫾ 25.8a;N⫽268
47.9 ⫾ 17.5a;N⫽282
51.0 ⫾ 15.6a;N⫽289
57.0 ⫾ 13.8a;N⫽276
54.4 ⫾ 23.6a;N⫽287
41.8 ⫾ 24.0a;N⫽282
43.7 ⫾ 19.4a;N⫽284
50.5 ⫾ 24.5a;N⫽285
53.1 ⫾ 24.1b;N⫽245
51.4 ⫾ 18.9a;N⫽275
49.7 ⫾ 14.5a;N⫽281
59.8 ⫾ 15.0a;N⫽273
57.1 ⫾ 22.8ab;N⫽282
46.7 ⫾ 26.3a;N⫽277
51.1 ⫾ 20.3b;N⫽273
59.4 ⫾ 26.4b;N⫽223
65.4 ⫾ 23.6c;N⫽171
60.8 ⫾ 19.7b;N⫽204
56.9 ⫾ 18.2b;N⫽216
65.7 ⫾ 16.4b;N⫽187
62.3 ⫾ 25.0b;N⫽209
58.6 ⫾ 24.5b;N⫽215
61.5 ⫾ 19.4c;N⫽168
430.2 ⫾ 50.6a¶
53.8 ⫾ 7.8a
6.9 ⫾ 5.7a
7.6 ⫾ 0.5¶
2.3 ⫾ 0.8a
1.4 ⫾ 2.3a
419.3 ⫾ 49.8b
52.4 ⫾ 6.7a
8.4 ⫾ 5.9b
7.6 ⫾ 0.5
2.5 ⫾ 0.8b
2.3 ⫾ 3.4b
389.9 ⫾ 53.9c
48.0 ⫾ 7.9b
11.3 ⫾ 6.7c
7.6 ⫾ 0.5
2.6 ⫾ 0.7b
4.0 ⫾ 5.1c
208 (65.8%)
216 (68.4%)
156 (54.7%)
167 (58.4%)
90 (40.5%)
96 (43.2%)
53.1 ⫾ 17.3a N⫽250
60.5 ⫾ 13.6a;N⫽254
4.2 ⫾ 1.0a;N⫽272
2.2 ⫾ 1.2a;N⫽267
5.1 ⫾ 3.5a;N⫽262
96 (35.3%)
54.6 ⫾ 17.3a;N⫽340
61.8 ⫾ 13.9b;N⫽348
4.2 ⫾ 0.9a;N⫽363
2.2 ⫾ 1.1a;N⫽362
5.3 ⫾ 3.3a;N⫽352
150 (41.3%)
61.5 ⫾ 18.4b;N⫽160
64.7 ⫾ 15.9b;N⫽160
3.9 ⫾ 1.1b;N⫽187
2.5 ⫾ 1.2b;N⫽186
5.9 ⫾ 3.4a;N⫽180
88 (47.1%)
3.6 ⫾ 0.9a; N⫽313
2.8 ⫾ 0.9a; N⫽317
3.6 ⫾ 1.2a; N⫽313
2.8 ⫾ 0.6a; N⫽312
3.0 ⫾ 1.1a; N⫽316
254 (79.9%)
256 (80.3%)
186 (58.3%)
3.2 ⫾ 0.9b; N⫽199
2.3 ⫾ 0.9b; N⫽199
3.2 ⫾ 1.1b; N⫽200
3.0 ⫾ 0.6b; N⫽198
2.8 ⫾ 1.2ab;N⫽200
143 (71.1%)
142 (70.6%)
109 (54.5%)
2.8 ⫾ 0.9c;N ⫽304
1.9 ⫾ 0.9c; N⫽304
2.8 ⫾ 1.2c; N⫽304
3.1 ⫾ 0.8b; N⫽303
2.7 ⫾ 1.1b; N⫽304
193 (63.9%)
214 (71.1%)
138 (45.4%)
TFEQ indicates Three-Factor Eating Questionnaire; EDI-2, Eating Disorders Inventory-2.
a, b, c
denote post hoc differences significant at P ⬍.05. Like superscripts indicate non-significant differences.
*P ⬍ .05
**P ⱕ .001;
†
Unless noted otherwise, entries are means ⫾ standard deviations.
‡
Possible TFEQ scores: Disinhibition, 0 to 16; Cognitive Restraint, 0 to 21; Hunger, 0 to 14.
§
Unless otherwise noted, N ⫽ 226 lowest tertile, N ⫽ 288 middle tertile, N ⫽ 318 highest tertile.
储
For the 62 food items, responses from 1 (Dislike extremely) to 4 denoted dislike. Responses from 5 to 9 (Like extremely) represented liking the item. Possible
scores range from 62 to 558; higher scores denote greater food preference.
¶
N ⫽ 316
#
Food like index ⫽ Preference score of food items liked (denoted by a preference selection of 5 to 9) divided by number of food items liked. Possible range
5 through 9; higher score denotes greater preference.
††
Food dislike index ⫽ Preference score of food items disliked (denoted by a preference selection of 1 to 4) divided by number of food items disliked. Possible
range 1 through 4; higher score denotes greater dislike.
‡‡
N ⫽ 285, 277, and 221 for highest, middle, and lowest tertiles, respectively.
§§
Compared to pre-action stage of change for each tertile.
储储
1 ⫽ Always, 5 ⫽ Never
¶¶
1 ⫽ Never, 5 ⫽ Almost always
##
Compared to Does not self impose dietary changes or restrictions for each tertile.
***1 ⫽ Does not do; 5 ⫽ Almost always does
†††
Compared to ⱕ 3 times per week
‡‡‡
Compared to ⱕ 15 minutes
§§§
Compared to “not liking or not minding” to cook
Table 5. Comparative Profiles of Eating Competence Levels†
Middle Tertile
N⫽272
31.32 ⫾ 1.7b
Low Tertile
N⫽299
23.33 ⫾ 3.9c
Not Eating
Eating Competent‡
Competent‡
N⫽384
N⫽448
37.59 ⫾ 4.4
25.54 ⫾ 4.5
13.74 ⫾ 1.6a
11.34 ⫾ 2.3a
6.59 ⫾ 1.8a
8.11 ⫾ 1.2a
11.26 ⫾ 2.2b
8.46 ⫾ 2.4b
4.86 ⫾ 1.8b
6.74 ⫾ 1.4b
8.50 ⫾ 2.5c
6.05 ⫾ 2.6c
3.39 ⫾ 1.7c
5.40 ⫾ 1.6c
13.11 ⫾ 2.0
10.57 ⫾ 2.6
6.18 ⫾ 1.8
7.73 ⫾ 1.4
51 (19.8)
206 (80.2)
39.8 ⫾ 13.6aN⫽257
25.3 ⫾ 5.5aN⫽255
109 (41.8)
2.78 ⫾ 1.1a N⫽257
4.41 ⫾ .9a N⫽258
59 (22.0)
209 (78.0)
35.6 ⫾ 13.5bN⫽266
25.4 ⫾ 5.6aN⫽263
119 (43.7)
3.16 ⫾ 1.1b N⫽268
4.11 ⫾ .9bN⫽268
64 (21.6)
75 (19.9)
232 (78.4)
302 (80.1)
33.7 ⫾ 12.5bN⫽296 38.8 ⫾ 13.5 N⫽375
27.2 ⫾ 6.3bN⫽292 25.2 ⫾ 5.5 N⫽374
169 (56.5)
159 (41.4)
3.67 ⫾ 1.1cN⫽296
2.86 ⫾ 1.1 N⫽377
3.96 ⫾ 1.0bN⫽296 4.34 ⫾ .9 N⫽378
99 (22.3)
345 (78.7)
34.1 ⫾ 13.0 N⫽444
26.7 ⫾ 6.1 N⫽436
238 (53.1)
3.54 ⫾ 1.1 N⫽444
3.99 ⫾ 1.0 N⫽444
68 (26.3)
191 (73.7)
110 (40.6)
161 (59.4)
167 (56.8)
127 (43.2)
115 (30.2)
266 (69.8)
230 (51.9)
213 (48.1)
89 (34.4)
170 (65.6)
198 (79.2)
131 (48.5)
139 (51.5)
157 (64.9)
148 (50.5)
145 (49.5)
158 (56.2)
145 (38.2)
235 (61.8)
279 (77.1)
223 (50.5)
219 (49.5)
234 (56.9)
2.35 ⫾ .8a; N⫽239
7.72 ⫾ .5a; N⫽260
1.71 ⫾ 2.8a;N⫽261
204 (79.1)
2.43 ⫾ .7ab; N⫽257
7.59 ⫾ .5b; N⫽272
2.56 ⫾ 3.8b;N⫽272
189 (70.5)
2.52 ⫾ .8b; N⫽287
7.52 ⫾ .5b; N⫽298
2.86 ⫾ 4.3b;N⫽299
183 (61.8)
2.39 ⫾ .8; N⫽356
7.68 ⫾ .5; N⫽383
1.75 ⫾ 2.8;N⫽384
292 (77.2)
2.48 ⫾ .7; N⫽427
7.54 ⫾ .5; N⫽447
2.96 ⫾ 4.3;N⫽448
284 (64.0)
8.45 ⫾ 5.0a;N⫽236
4.94 ⫾ 3.5a;N⫽250
4.55 ⫾ 3.0a;N⫽250
8.90 ⫾ 4.9ab;N⫽254
6.53 ⫾ 3.7b;N⫽262
5.42 ⫾ 3.5b;N⫽260
9.54 ⫾ 5.1b;N⫽267
8.01 ⫾ 4.1c;N⫽289
6.07 ⫾ 3.4b;N⫽284
8.63 ⫾ 4.9;N⫽348
5.48 ⫾ 3.6:N⫽367
4.8 ⫾ 3.2;N⫽367
9.29 ⫾ 5.1;N⫽409
7.50 ⫾ 4.0:N⫽434
5.88 ⫾ 3.4;N⫽427
44.2 ⫾ 19.7a;N⫽245
43.0 ⫾ 25.2a;N⫽231
49.0 ⫾ 19.7b;N⫽246
51.1 ⫾ 24.4b;N⫽228
59.1 ⫾ 20.5c;N⫽234 45.3 ⫾ 19.5;N⫽357
63.5 ⫾ 25.0c;N⫽225 43.8 ⫾ 24.8;N⫽335
55.8 ⫾ 20.8;N⫽368
60.7 ⫾ 24.6;N⫽349
9.28 ⫾ 2.6
6.72 ⫾ 2.7
3.75 ⫾ 1.8
5.79 ⫾ 1.6
Journal of Nutrition Education and Behavior ● Volume 39, Number 5S, September/October 2007
ecSatter Inventory Scores§
Total**
Subscales:
Eating attitudes**
Contextual skills**
Food acceptance**
Internal regulation**
Sex
Male
Female
Age y**
Self-reported body mass index**
Overweight (BMI ⱖ 25)**
Weight satisfaction **1⫽very satisfied, 5⫽very unsat
Worry about money for food 1⫽always, 5⫽never**
Stage of change Fruit:**
Preaction
Post action
Stage of change: Vegetable:**
Preaction
Post action
Yes, self-reports physically active**
Food preference:储
Dislike index*,***
Like index**
Number foods never tried**
Yes, Prepares Food from Scratch
TFEQ¶
Restraint scale*,***
Disinhibition**:
Hunger**
Eating disorder inventory-2#
Drive for thinness**
Body dissatisfaction**
High Tertile
N⫽261
39.77 ⫾ 3.7a
S161
S162
Table 5. Continued
Middle Tertile
59.7 ⫾ 14.5b;N⫽245
51.8 ⫾ 19.1b;N⫽257
54.6 ⫾ 17.0b;N⫽246
50.9 ⫾ 25.5a;N⫽265
45.2 ⫾ 24.7a;N⫽254
Low Tertile
65.2 ⫾ 16.6c;N⫽245
59.2 ⫾ 20.3c;N⫽260
61.6 ⫾ 18.6c;N⫽256
57.0 ⫾ 26.2b;N⫽281
57.7 ⫾ 25.6b;N⫽271
Eating Competent‡
60.0 ⫾ 13.7;N⫽356
48.1 ⫾ 17.6;N⫽359
50.7 ⫾ 15.5;N⫽356
47.4 ⫾ 25.3;N⫽373
41.7 ⫾ 24.5;N⫽364
Not Eating
Competent‡
63.3 ⫾ 16.1;N⫽380
56.7 ⫾ 19.9;N⫽402
60.0 ⫾ 18.5;N⫽394
54.8 ⫾ 26.0;N⫽426
54.0 ⫾ 25.7;N⫽410
2.51 ⫾ .8a; N⫽257
2.23 ⫾ .9b; N⫽264
2.00 ⫾ .9c; N⫽295
2.46 ⫾ .8; N⫽375
2.05 ⫾ .8; N⫽441
2.61 ⫾ .7a; N⫽257
2.41 ⫾ .7a; N⫽256
1.38 ⫾ .7a; N⫽255
2.46 ⫾ .8ab;N⫽265
2.17 ⫾ .8b; N⫽266
1.50 ⫾ .8a; N⫽265
2.39 ⫾ .8b; N⫽295
1.92 ⫾ .7c; N⫽294
1.69 ⫾ .8b; N⫽295
2.58 ⫾ .7; N⫽374
2.37 ⫾ .7; N⫽374
1.42 ⫾.7; N⫽373
2.40 ⫾ .8; N⫽443
1.98 ⫾ .7; N⫽442
1.63 ⫾ .8; N⫽442
BMI indicates body mass index; TFEQ, Three-Factor Eating Questionnaire.
*P ⬍ .05
**P ⱕ .001
***P ⬍ .1
a, b, c
denote post hoc differences significant at P ⬍.05. Like superscripts indicate non-significant differences.
†
Table entries are either frequencies (% of cell) or mean ⫾ standard deviation. Listing one significance symbol denotes same significance level for tertile as well as eating competence category comparisons. If two
symbols are listed, the first listed symbol denotes tertile comparison; the second symbol references the eating competence category comparison.
‡
Eating competence denoted by ecSatter Inventory score ⱖ 32; Not eating competent ecSatter Inventory score ⬍ 32.
§
Higher scores indicate eating competence, possible ranges: Total score 0-48, respective subscale ranges 0-15, 0-15, 0-9, 0-9.
储
Food Dislike Index ⫽ Preference Score of foods disliked (denoted by a preference selection of 1 to 4) divided by number of foods disliked. Possible range 1 through 4; higher score denotes greater dislike. Food
Like Index ⫽ Preference Score of foods liked (denoted by a preference selection of 5 to 9) divided by number of foods liked. Possible range 5 through 9; higher score denotes greater preference.
¶
Possible TFEQ scores: Disinhibition, 0 to 16; Cognitive Restraint, 0 to 21; Hunger, 0 to 14.
#
Entry is normed percentile.
††
1⫽Do not do; 5⫽Almost always do
Lohse et al/MEASURING EATING COMPETENCE
Ineffectiveness**
Interpersonal distrust**
Lack of interoceptive awareness**
Asceticism**
Social insecurity**
How often do you. . ...††
feel confident about managing your money to
make healthy food available to you?**
shop with a grocery list?*,**
plan meals ahead of time?**
run out of food before the end of the month?**
High Tertile
55.9 ⫾ 13.2a;N⫽246
46.5 ⫾ 16.2a;N⫽244
50.3 ⫾ 15.7a;N⫽248
45.4 ⫾ 24.7a;N⫽253
40.9 ⫾ 24.1a;N⫽249
Journal of Nutrition Education and Behavior ● Volume 39, Number 5S, September/October 2007
Eating Competence Subscales
Subscale structure indicated in preliminary, exploratory
work with college students11 was confirmed in this older,
slightly more female sample. As described in Table 1, the
16 ecSI items separated as 4 subscales, each with good
internal reliability: eating attitudes, food acceptance, internal regulation, and contextual skills. ecSI subscale validation is shown in Table 4. Strong associations between each
subscale and cognitive or behavioral responses, along with
gradient changes among ecSI score tertiles, provided confirming evidence of subscale validity.
Eating attitudes. Moving from low to high ecSI tertiles, decreases were noted in the tendency to think about
and engage in bulimia, drive for thinness, body dissatisfaction, feelings of ineffectiveness and inadequacy, tendency
toward impulsivity, fear of maturation, tendencies to be
ascetic or to have feelings of alienation, and insecurity
about personal relationships. In addition, disinhibition and
cognitive restraint toward eating significantly decreased
going from lower to higher subscale tertiles. Eating attitude
subscale scores were significantly (all P ⬍ .001) inversely
associated with disinhibition (r ⫽ ⫺0.41), restrained eating
(r ⫽ ⫺0.33), body dissatisfaction (r ⫽ ⫺0.34), and desire
to be thin (r ⫽ ⫺0.34).
Food acceptance. Percentage of persons in postaction
for both fruits and vegetables increased from low to medium
to high tertiles. Greater food preference and fewer dislikes
were noted from low to high food acceptance tertiles. In
addition, food acceptance subscale scores were significantly
related (all P ⬍ .001) to total food preference score (r ⫽
0.33), number of food likes (r ⫽ 0.33), dislikes (r ⫽ ⫺0.29),
and food never tried (r ⫽ ⫺0.29).
S163
and successfully cooking from scratch. Types of food prepared varied according to contextual skills, with higher
tertiles preparing more healthful (63% vs. 47.5% vs. 29.8%,
P ⬍ .001), and less frozen (35.4% vs. 42.3% vs. 45.4%, P ⫽
.04) and speed-scratch (51.7% vs. 59.7% vs. 69.5%, P ⬍
.001) food.
Logistic Regression Analyses
Scores on the ecSI were dichotomized into being eating
competent (ⱖ 32) or not. The dichotomized ecSI score was
regressed onto 13 characteristics and behaviors theoretically connected to EC. Results, shown in Table 6, supported age, satisfaction with body weight, Stage of Change
for fruit and vegetable intake, physical activity, food preference, disinhibition, and cognitive restraint as predictors
of EC. For example, compared to persons satisfied or very
satisfied with their body weight, those unsatisfied or very
unsatisfied were 54% less likely to be eating competent; for
every unit increase in the Food Like index, likelihood of
being eating competent increased nearly threefold; for every unit increase in the disinhibition scale, the probability
of being eating competent decreased by 9%. Regression of
ecSI tertiles onto the same variables showed similar findings
for prediction of placement into the lowest tertile relative
to the highest tertile (Table 7). For example, persons unsatisfied with body weight were nearly 3 times more likely
to be in the lowest tertile than those satisfied with their
weight; physically active persons were 43% less likely to be
in the lowest EC tertile; and for each unit increase in the
dislike index, probability of being in the lowest tertile
nearly doubled. Of note is that sex, BMI, worry about
money for food, and home preparation of food were not
predictive of EC.
DISCUSSION
Internal
regulation. Interoceptive
unawareness
(meaning inability to identify visceral sensations related to
hunger and satiety), bulimic thoughts, and feelings of uncontrolled hunger significantly increased from high to low
internal regulation tertiles (Table 4). Post hoc analyses
revealed low tertile findings differed from high and/or medium tertiles. Self-imposed dietary restrictions were associated with lower levels of internal regulation, but those
based on health professional recommendation or allergies
were not tertile specific. This subscale appeared to capture
a food insufficiency element, because worry about money
for food was significantly greater in the lowest tertile, and
frequency of monthly food shortage increased from high to
low tertiles.
Contextual skills. The higher the contextual skill tertile, the greater the practice of planning meals, using all
food groups and nutrition facts labels, eating at home,
cooking more frequently, taking longer to prepare a meal,
ecSI responses from a convenience sample of 863 adults
compared to outcomes from 5 validated instruments and
pretested food preparation questions affirmed ecSI construct validity. Differences in EC tertiles were clear and
concise as well as compatible with hypothesized relationships. As anticipated, tertile (for total and subscale scores)
increases were related to decreases in restrained eating,
disinhibition, hunger, weight dissatisfaction, food dislikes,
drive for thinness, and other indicators of eating disorders;
physical activity, stage of change for fruit and vegetable
intake, and food preparation all increased with tertile increases. Stunkard and Messick6 describe TFEQ scores for
adults (mean age 44 ⫾ 12.8, range 17-77) categorized as
dieters (N ⫽ 53, Restraint 14.3 ⫾ 3.6; Disinhibition 13.8 ⫾
4.2; Hunger 7.2 ⫾ 3.9) or free eaters (N ⫽ 45, Restraint 6.0
⫾ 5.5; Disinhibition 5.6 ⫾ 4.3; Hunger 7.0 ⫾ 4.3). Our
TFEQ scores followed a similar pattern across EC tertiles
with scores decreasing from low to high EC tertile. Concern
that convenience sampling would produce bias toward dis-
S164
Lohse et al/MEASURING EATING COMPETENCE
Table 6. Predicting Eating Competence†
Eating Competence
Sex‡
Age§
25-49 years
⬎49 years
Worry about money to buy food储
Aways/often
Sometimes
Satisfaction with current weight¶
Neutral
Unsatisfied/very unsatisfied
Body mass index
Stage of change for fruits
Stage of change for vegetables
Physical activity#
Food preference: Dislike index††
Food Preference: Like index‡‡
Frequency of home food preparation§§
Everyday
Not everyday
TFEQ disinhibition scale
TFEQ restraint scale
Odds Ratio
1.22
Standard Errors
0.26
95% Confidence
Interval
0.74–2.01
2.23**
2.07*
0.25
0.31
1.36–3.65
1.13–3.78
0.58
0.88
0.46
0.25
0.24–1.43
0.54–1.44
0.66
0.46**
1.01
1.22**
1.12*
1.67*
0.72*
2.68**
0.26
0.27
0.02
0.07
0.06
0.21
0.13
0.21
0.40–1.10
0.27–0.78
0.97–1.05
1.06–1.39
1.00–1.26
1.12–2.51
0.56–0.93
1.76–4.07
1.03
0.60
0.91**
0.96*
0.38
0.35
0.03
0.02
0.49–2.16
0.30–1.19
0.86–0.96
0.92–1.00
TFEQ indicates Three-Factor Eating Questionnaire.
†
N⫽643
*P ⱕ .05
**P ⬍ .01
‡
Reference group⫽female
§
Reference group⫽⬍25 years old
储
Reference group⫽Never worrying
¶
Reference group⫽Very satisfied/satisfied
#
Reference group⫽Do not consider themselves physically active
††
Food Dislike Index ⫽ Preference Score of foods disliked (denoted by a preference selection of 1 to 4) divided by number of foods disliked. Possible range
1 through 4; higher score denotes greater dislike.
‡‡
Food Like Index ⫽ Preference Score of foods liked (denoted by a preference selection of 5 to 9) divided by number of foods liked. Possible range 5 through
9; higher score denotes greater preference.
§§
Reference group⫽Do not prepare their own food
ordered eating was abated by the fact that TFEQ subscale
scores were lower than dieters, even for those not considered eating competent or in the lowest EC tertile. Boschi et
al compared persons seeking weight management counseling with controls and demonstrated that TFEQ scores reflect impaired eating behavior.13 Our TFEQ scores more
closely aligned with their controls. In addition, ecSI internal reliability and content validity were confirmed.
Strengths of this study included a large sample with age,
education, and geographic diversity and comparison of ecSI
with several validated instruments. In addition, the ecSI
was placed in either the front or back of this large survey
booklet to address order bias, and no significant differences
were found, with the exception of BMI (front: 26.4 ⫾ 5.9,
back: 25.5 ⫾ 5.9) and proportion of overweight (front:
51.7%, back: 58.9%); practical significance of theses differences is questionable, however, because BMIs differed by
less than one unit and overweight status was greater than
50% for both groups. To economically obtain a geographically disparate and diverse sample traditional and on-line
instrument distribution were used. Scores on the ecSI and
subscales did not differ by completion method, but the
on-line group appeared to be older (38.3 ⫾ 12.0 vs. 34.6 ⫾
14.2 years) with a higher BMI (27.1 ⫾ 6.5 vs. 25.1 ⫾ 5.3)
and greater proportion of overweight (54.1% vs. 37.7%), as
well as dissatisfied with body weight both by EDI-2 Body
Dissatisfaction subscale percentile (55.0 ⫾ 25.6 vs. 50.5 ⫾
26.3) and direct response (3.4 ⫾ 1.2 vs. 3.1 ⫾ 1.1). On-line
respondents were more likely to be in preaction stages for
fruit intake (46.5% vs. 38.2%), have a greater number of
food items never tried (3.0 ⫾ 3.8 vs. 1.9 ⫾ 3.6), shop with
a grocery list (3.9 ⫾ 1.0 vs. 3.6 ⫾ 1.2), cook from scratch
(79.5% vs. 62.7%), have greater disinhibition (7.2 ⫾ 4.2 vs.
6.1 ⫾ 3.8), fewer food dislikes, and be less physically active
Journal of Nutrition Education and Behavior ● Volume 39, Number 5S, September/October 2007
S165
Table 7. Predicting Placement in Lowest Eating Competence Tertile Compared to Placement in Highest Tertile†
Eating Competence
Sex‡
Age§
25–49 years
⬎49 years
Worry about money to buy food储
Aways/Often
Sometimes
Satisfaction with current weight¶
Neutral
Unsatisfied/Very unsatisfied
Body mass index
Stage of change for fruit
Stage of change for vegetables
Physical activity#
Food preference: Dislike index††
Food Preference: Like index‡‡
Frequency of home food preparation§§
Everyday
Not everyday
TFEQ disinhibition scale
TFEQ restraint scale
Odds Ratio
0.76
Standard Errors
0.32
95% Confidence
Interval
0.40–1.42
0.47*
0.35**
0.33
0.40
0.25–0.89
0.16–0.77
1.60
1.78
0.57
0.33
0.53–4.88
0.93–3.39
1.70
2.93**
0.98
0.70**
0.86*
0.57*
1.76**
0.23**
0.34
0.35
0.02
0.09
0.08
0.27
0.14
0.27
0.88–3.28
1.48–5.82
0.93–1.02
0.58–0.83
0.74–0.99
0.34–0.96
1.33–2.33
0.13–0.39
0.92
2.09
1.21**
1.07*
0.50
0.47
0.04
0.03
0.35–2.45
0.84–5.22
1.12–1.30
1.01–1.12
TFEQ indicates Three-Factor Eating Questionnaire.
†
N⫽660
*P⬍.05
**P⬍ .01
‡
Reference group⫽male
§
Reference group⫽⬍25 years old
储
Reference group⫽Never worrying
¶
Reference group⫽Very satisfied/satisfied
#
Reference group⫽Do not consider themselves physically active
††
Food Dislike Index ⫽ Preference Score of foods disliked (denoted by a preference selection of 1 to 4) divided by number of foods disliked. Possible range
1 through 4; higher score denotes greater dislike.
‡‡
Food Like Index ⫽ Preference Score of foods liked (denoted by a preference selection of 5 to 9) divided by number of foods liked. Possible range 5 through
9; higher score denotes greater preference.
§§
Reference group⫽Do not prepare their own food
61.9% vs. 70%). However, most differences were marginal,
and although statistically significant, they lacked practical
significance. Separate factor analyses for each completion
method revealed 4 subscales accounting for 62% (paper
survey) or 59.7% (on-line) of the variance in ecSI scores.
Factor loadings were identical for both completion methods, with 2 exceptions: “I assume I will get enough to eat”
loaded on the Internal Regulation subscale for the on-line
group, but not on any factor for those using paper-pencil
(coefficient ⫽ 0.32), and “I enjoy food and eating” loaded
on the Eating Attitudes subscale for paper-pencil group but
not on any factor for on-line completers (coefficient ⫽
0.33). Removal of the assumption question produced identical factors for each method of completion and when
“eating enjoyment” was removed from the factor analysis,
the assumption question loaded on the Internal Regulation
subscale for on-line completers, but on Eating Attitudes for
the paper-pencil format. Absence of ecSI differences, comparatively small differences for other variables, and benefits
of a larger sample size supported combining on-line and
paper-pencil responses.
An association of EC with dietary behavior is supported
by the fact that food preparation from scratch and meal
planning were more frequently practiced by eatingcompetent persons; better diet quality has been reported for
young adults who prepare food.14 Scores on the ecSI differed significantly (P ⬍ .001) between those who enjoyed
cooking (32.4 ⫾ 7.4) and those who reported either not
liking or not minding cooking (29.7 ⫾ 7.4), suggesting that
learning food preparation skills enhances EC and potentially dietary quality. Using three 24-hour food recalls,
Psota, Lohse, and West found significant correlations with
EC and sugar (inverse) and fiber (positive) intakes, suggesting further exploration into the relationship between eating
S166
Lohse et al/MEASURING EATING COMPETENCE
competence and the nutrition goals included in current
government dietary guidance.15 A possible connection between eating competence and diet quality is made more
remarkable because in the ecSatter model, cognitive and
affective guidance about eating replace the usual food and
nutrient recommendations.1,2
Eating competence is related to indicators of health
status. For example, although not predictive of EC, BMI
was significantly lower in higher EC tertiles. A greater
proportion of eating-competent persons (ecSI score ⱖ 32)
self-identified as being physically active, and a more healthful cardiovascular biomarker pattern has been shown in
eating-competent persons,15 that is, HDL cholesterol was
higher, triglycerides lower, systolic and diastolic blood pressure lower, and soluble vascular cell adhesion molecule-1
lower. In addition, higher tertiles of EC had a significantly
greater (P ⬍ .001) preference for fruits and vegetables.
Given the associated health benefits, education that
develops EC appears prudent. Current nutrition education
efforts focused on nutrient and food selection information
have been shown to be ineffective for increasing EC.16 In a
study of 334 non-nutrition major undergraduates, ecSI
scores remained low (baseline, 30.09 ⫾ 6.9; semester end,
30.11 ⫾ 6.8) and decreased from 32.7 ⫾ 6.5 to 32.1 ⫾ 6.2
in males (N ⫽ 78). Educational interventions with an
alternative focus provide an optimistic outlook.2 The sample in this study included 83 respondents who had participated in ecSatter model workshops and classes. Workshop
participant ecSI scores were significantly higher (37.6 ⫾ 6.9
vs. 30.3 ⫾ 7.3, P ⬍ .001); although workshop participants
were older (45.02 ⫾ 9 vs. 35.8 ⫾ 13.5 years; P ⬍ .001), ecSI
scores remained higher even when corrected for age (workshop participant age-adjusted ecSI score was 36.9). These
higher scores were accompanied by significantly lower
TFEQ Disinhibition and Hunger scores, less food dislike,
greater satisfaction with body weight, and lower EDI-2
scores (data not shown).
IMPLICATIONS FOR RESEARCH AND
PRACTICE
The quest for a healthful weight, dietary quality, and
healthful food behaviors appears to be a search for EC.
Educational needs assessments and interventions to enhance EC require a valid instrument to assess EC and to
measure postintervention changes in EC. This study provides support of content and construct validity, as well as
internal consistency of the ecSI for healthy adults in the
general population. Further research will be needed to
examine ecSI usefulness for measuring EC with groups that
are not healthy, food insecure, nonwhite, younger than 18
years, or older than 70 years. In addition, findings from this
validation study demonstrate the significant component
psychological traits play in understanding eating behaviors,
thus supporting design of nutrition education interventions
that move beyond information dissemination to those that
embrace cognitive and affective tenets of behavior change.
ACKNOWLEDGMENT
Funding was provided by The Sunflower Foundation, Topeka, Kansas, and the Family Nutrition Program of Kansas
State University with funding from USDA’s Food Stamp
Nutrition Education Program. The authors would like to
acknowledge the work of Amy McCabe, Elizabeth Condron, and Elizabeth Barrett in completing this study.
REFERENCES
1. Satter EM. Eating competence: Definition and evidence for the Satter
eating competence model. J Nutr Educ Behav (suppl). 2007;39:S142S153.
2. Satter E. Eating competence: Nutrition education with the Satter
eating competence model. J Nutr Educ Behav (suppl). 2007;39:S189S194.
3. Garner DM. Eating Disorder Inventory-2, Professional Manual. Lutz,
Fl: Psychological Assessment Resources, Inc.; 1991.
4. Stotts JL, Lohse B. Reliability of the ecSatter inventory as a tool to
measure eating competence. J Nutr Educ Behav (suppl). 2007;39:S167S170.
5. Lohse Knous B, Oakland MJ, Satter E, Wooden J, Barrett E. Characteristics of persons who underperceive consumption of three or more
daily servings of vegetables. FASEB J. 2003;17:A287.
6. Stunkard AJ, Messick S. The three-factor eating questionnaire to
measure dietary restraint, disinhibition and hunger. J Psychosom Res.
1985;29:71-83.
7. Drewnowski A, Hann C. Food preferences and reported frequencies of
food consumption as predictors of current diet in young women. Am J
Clin Nutr. 1999;70:28-36.
8. Horacek TM, White A, Betts NM, et al. Self-efficacy, perceived
benefits, and weight satisfaction discriminate among stages of change
for fruit and vegetable intakes for young men and women. J Amer Diet
Assoc. 2002;102:1466-1470.
9. USDA Cooperative State Research Education and Research Service,
Nutrition, Evaluation/Reporting System (ERS4), An Evaluation tool
of the Expanded Food and Nutrition Education Program (EFNEP).
Available at: http://www.csrees.usda.gov/nea/food/efnep/ers/ers4.html.
Accessed August 17, 2007.
10. Drewnowski A, Hann C, Henderson SA, Gorenflo D. Both food
preferences and food frequency scores predict fat intakes of women
with breast cancer. J Amer Diet Assoc. 2000;100:1325-1333.
11. Knous BL, Oakland MJ, Satter E, Wooden J, Barrett E. 16-item scale
to assess eating competence in emerging adults. FASEB J. 2002;16:
A254.
12. Blitstein J, Evans D. Use of nutrition fact panels among adults who
make household food purchasing decisions. J Nutr Educ Behav. 2006;
38:360-364.
13. Boschi V, Iorio D, Margiotta N, D’Orsi P, Falconi C. The three-factor
eating questionnaire in the evaluation of eating behaviour in subjects
seeking participation in a dietotherapy programme. Ann Nutr Metab
2001;45:72-77.
14. Larson NI, Perry CL, Story M, Neumark-Sztainer D. Food preparation
by young adults is associated with better diet quality. J Amer Diet
Assoc. 2006;106:2001-2007.
15. Psota TL, Lohse B, West SG. Associations between eating competence and cardiovascular disease biomarkers. J Nutr Educ Behav
(suppl). 2007;39:S171-S178.
16. Shafer K, McCabe A, Condron E, et al. Examining eating competence
change in a general nutrition course reveals gender and food preparation issues. Society for Nutrition Education Annual Conference Proceedings. 2003;36:43.