Pregnancy: The joy of eating 

by Ellyn Satter, Registered Dietitian and Family Therapist

Dieting doesn’t work during pregnancy. Neither does eating haphazardly. Instead, learn to eat competently, based on the Satter Eating Competence Model (ecSatter).¹ Discover the Joy of Eating:

• Feed yourself faithfully. Reassure yourself you will be fed. Structure is the supportive framework for taking care of yourself with food.
• Give yourself permission to eat. Reassure yourself: “It’s all right to eat. I just need to sit down and enjoy.”

According to the ecSatter Inventory, a validated paper-and-pencil questionnaire, people who have high eating competence do well nutritionally and with weight.²

You have your own pattern

ecSatter and The Joy of Eating support you in being nurturing and trusting with feeding yourself and gaining weight in your own distinctive pattern during pregnancy. The primary nutrition goal of ecSatter is structure and the primary intervention is meal planning. Within the context of structure, manage your energy intake by paying attention to your internal regulators of hunger, appetite and satiety. The best pattern of weight gain for you and your baby grows out of your respecting and paying attention to yourself.

Take care of yourself with food

Be positive and reliable about taking care of yourself with food. Emphasize three meals a day and as many snacks as necessary to feel comfortable and energetic. Don’t burden yourself with food prescriptions, portion sizes, and patterns. Instead, choose food you enjoy at three meals a day with and snacks is you need them. Include nutritious food, not because you have to, but because you enjoy it.³ For you to be faithful about feeding yourself, your food must be richly rewarding to plan, prepare, provide and eat.⁴

Eat as much as you are hungry for

 Reliably providing yourself with appealing food at predictable times and attending to your internal cues will allow you to will do well nutritionally and gain weight in a way that is right for you.

Go to meals and snacks hungry but not famished, pay attention to your eating, enjoy it, and eat until your hunger goes away and your food stops tasting as good. You will stop because you lose interest in eating and because you know another meal or snack is coming soon when you can do it all over again. As you connect with your food over and over again, your sensations of hunger and fullness will become stronger and more reliable.

Trust your body

Pregnancy is a wonderful time to discover and trust your body’s unique wisdom. Cultivate your curiosity. Your pattern of weight gain may follow the standard graphs or it may be unique to you. Your hunger and appetite will vary, from month-to-month, and among the first, second, and third trimesters. Reliably providing yourself with appealing food at predictable times and attending to your internal cues will allow you to do well nutritionally and gain weight in a way that is right for you.

The Satter Eating Competence Model does no harm

ecSatter is based on trust in you to act on your 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
• 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

Family meals start during pregnancy

If I could wave a magic wand, I would make eating competence counseling available to all prospective parents, helping them to establish family meals and develop positive eating attitudes and behaviors that are likely to persist after their 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 on behalf of their babies. They most often come in doubting that they are eating well and go out recognizing that they are doing lots better than they thought they were. 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 eating.