ORIGINAL ARTICLE

Creation of the Brazilian Center of Mindful Eating: recovery of conscience and love when eating^*

Ana Paula Leme de Souza^I,II; Fernanda Rodrigues de Oliveira Penaforte^III; Livia Dayane Sousa Azevedo^IV; Driele Cristina Gomes Quinhoneiro^V; Rosane Pilot Pessa^I

^IUniversidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
^IIScholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
^IIIUniversidade Federal do Triângulo Mineiro, Departamento de Nutrição, Uberaba, MG, Brazil
^IVUniversidade de São Paulo, Faculdade de Medicina, Ribeirão Preto, SP, Brazil
^VCentro Brasileiro de Mindful Eating, São Paulo, SP, Brazil

Corresponding author

ABSTRACT

OBJECTIVE: to describe the trajectory of the creation of the Brazilian Center of Mindful Eating and to attempt to understand the motivations, objectives, the already obtained results, as well as the future perspectives and challenges of this organization.
METHOD: exploratory descriptive study with a qualitative design. Data collection was carried out by consulting the documents available on the Center's website and compiling the accounts given by the professionals involved in conceiving and creating the Center. The obtained information was sorted into categories so as to provide a consistent description of said Center as a milestone for the mindful eating scientific and professional movement.
RESULTS AND DISCUSSION: creating the Center required: Organization and structure: independence, decentralization and horizontality; Objectives and motivations: love, care and ethics; Challenges and future perspectives: cultivating, taking care of and reaping the benefits of it. Those categories, explored together, have shown how important it was to create the Center to cooperate, among other things, to inaugurate the topic in Brazil.
CONCLUSION: the Center has been contributing to the ethical professional development of this field of knowledge in Brazil and has been establishing itself so as to organize and be the reference to disseminate such practices. Studies based on this subject may contribute to strengthen Mindful Eating as an important resource for health and quality of life.

Descriptors: Mindfulness; Feeding Behavior; Quality of Life; Health Promotion.

Introduction

Meditation practices can act as self-observation activities aiming at cultivating calm, generosity, compassion, concentration, ethics, and self-regulation of attention to the conscience of immediate experiences⁽¹⁾. Meditation can also cover a group of complex abilities of attention and emotion regulation, which can be developed in several contexts, such as the cultivation of well-being and of emotional balance⁽²⁾.

Thus, as a mental skill, the Mindfulness practice can be developed through secular meditation^(3-4) and can be defined as the practice of turning attention to the present moment intentionally, with openness, curiosity, and acceptance, without judging the experience, whether it is pleasant or not⁽⁵⁾.

For those who begin the Mindfulness meditations, it is common to receive guidance on the breathing practice as a meditation of focused attention⁽⁶⁾. Thus, frequent practice can make the practitioners turn their attention focus to the present moment, as well as to the physical sensations related to breathing. Gradually, the practitioner is encouraged to expand the attention into the sensations of the entire body, perceiving the present emotions, thoughts, and other mental processes that may arise, in addition to treating each one of these contents with equanimity, that is, without intentions of analysis, desires or dislikes, when observing them in relation to how they emerge, change, or cease to exist^(7-8).

However, it is also possible to understand and develop Mindfulness as a mental skill, as a fluid cognitive state that results from new interpretations about the situation and the environment. By being attentive, it is possible to be actively involved in the present and in the context of the situation, with the possibility of elaborating other perspectives. The ability to visualize objects and situations from several perspectives and, depending on the context, to observe the possibility of changing the perspective, are characteristics of a conscious cognitive state. This cognitive state differs from the Mindfulness meditation practices, although the post-meditative states can result in attention in the cognitive sense^(9-10).

Among the abilities exercised in the Mindfulness practices, it is also possible to identify the cultivation of metacognition to act correctly. In this sense, the practice can turn attention to what is making sense at every moment, and thus have the possibility of truly seeing the origin of the individual's own acts. By allowing the person to become aware of the behaviors, words or thoughts motivated by feelings of greed, hatred and illusion, or of goodness and compassion, Mindfulness also makes an association with a moral conscience and can be characterized as a type of ethical intuition⁽¹¹⁾.

In the same direction, Mindful Eating can be understood as the conscience without judgment in relation to other physical and emotional sensations associated with eating⁽¹²⁾, which includes being attentive to the flavor of the food in the mouth, and the conscience of the signs of hunger and satiety, in addition to the emotions which emerge when eating⁽¹³⁾. MindfulEating offers the opportunity of developing the autonomy and permission for a conscious choice of any type of food, without judgments, and values the entire experience involved in the act of eating, the effects of the food in the physical and emotional sensations before, during and after eating, by turning each meal into a moment of self-care and kindness to oneself^(14-15).

Despite being a recurrent theme, especially in the national scene, the interest in Mindfulness and MindfulEating has increasingly grown in the last years, with expansion in the number of research studies, in the health professionals' interest in this work line, and also in its implementation in health programs⁽¹⁶⁾. In this perspective, it is necessary to be cautious so that there are no distortions in the concepts and principles of the approaches focused on Mindfulness and on MindfulEating, avoiding trivializations or wrong applications, aiming at respecting the ethics and the commitment to its rules, as well as to preserve the diversity that can be approached through secular practice. Therefore, for a sustainable development to exist in this new field of knowledge, it is necessary to articulate the definitions, principles, and guidelines of what Mindfulness and MindfulEating are and of what they are not^(14-17).

From this scenario, professionals working in the area gathered around one common objective: caring for the field of Mindful Eating in Brazil; and founded the Brazilian MindfulEating Center (Centro Brasileiro de Mindful Eating, CBME), aiming to ease the process of (re)building a harmonic relationship with food and with the body by those who seek this path.

Objective

To describe the creation path of the Brazilian MindfulEating Center (CBME) and seek to understand the motivations, objectives, and results already achieved, as well as the perspectives and challenges for the future of this organization.

Method

This is a descriptive and exploratory study with a qualitative design. The qualitative research was chosen because it deeply investigates a given topic, and because it is concerned with the degree of reality that cannot be quantified. Therefore, it works with the universe of meanings, reasons, expectations, values, and attitudes by allowing the researcher to assign meanings to a certain phenomenon in an interpretive and understanding manner^(18-19).

The data were collected by means of consultation to the documents available in the CBME website about its history, values, mission, and organization. Reports were also collected individually through phone calls with the professionals involved in its idealization and creation. The interview contained questions on the objectives, motivations, difficulties, and perspectives involved in the process of construction and consolidation of the CBME. It is worth mentioning that one of the authors of the article is also one of the creators and the current director of the CBME, with active participation since its inception, which contributed to the search of the necessary information to answer to the objective of this study.

Reports and documents composed the analytical corpus of this study. This corpus was analyzed by thematic content analysis that bears the conception of a topic linked to a statement regarding a certain subject matter, allows for several relationships, and can be graphically represented by means of a word, a phrase, or a summary⁽²⁰⁾. This procedure gives an opportunity to understand the essence of the descriptions, whose frequency or presence will have a meaning for the target analytical object⁽¹⁸⁾. The stages included in the thematic analysis are the following: pre-analysis; exploration of the material; treatment of the data obtained; and interpretation. In the pre-analysis, all the interviews were read exhaustively, which is called "floating read", allowing for the first impression to emerge. After this stage, all the content of interest was organized within the thematic axes, which were defined a posteriori. Then, the messages were clustered in categories by common characteristics, from this organized content⁽²⁰⁾.

In order to accomplish the work, the precepts from Resolution 466/12 of the National Health Council (Conselho Nacional de Saúde, CNS) were observed, in which the principles of autonomy, beneficence, non-maleficence, and justice/equality were respected.

Results and Discussion

The documents made available by the organization's directors, the information from the CBME website, and the interview carried out with three of the four current CBME directors resulted in the identification of three thematic categories, that will be described and discussed below: (a) Structural organization: independence, decentralization, and horizontality; (b) Objectives and motivations: love, care, and ethics; and (c) Challenges and future perspectives: seeding, caring, and harvesting.

Structural organization: independence, decentralization, and horizontality

The CBME is an independent and non-profit organization, created in 2016. Besides helping in establishing MindfulEating in Brazil, this organization has brought with itself the joint effort of five professionals to structure a place that could be a source of support both for professionals wishing to work in the area, and for people wishing more sustainable and significant ways of relating with food, with eating, and with the body. Throughout this journey, the CBME has been strengthening itself and is currently led by four women, a physician, two nutritionists, and an anthropologist.

Similarly to what was observed for the creation of the Centers for Psychosocial Care, whose inspiration mostly arises from experiences abroad⁽²¹⁾, the creation of the CBME was also inspired in the international experience of The Center for Mindful Eating (TCME). Created in 2006 in the United States of America, the TCME is also a non-profit organization that makes efforts to ensure that the information relating to Mindful Eating reaches in a correct and accessible manner the training of the professionals on the principles and on the conscious eating practices, by means of the promotion of knowledge, full attention, and ethical action in education, politics, research, and health related to eating⁽²²⁾.

Initially, the CBME was organized linked to a public higher education institution. After a brief period, there was a mobilization of its motivated creators, among other factors, by their personal practices of Mindfulness and Mindful Eating, so that it could become an independent organization, aiming at building its own path, objective, mission, and values. Currently, the CBME has no physical headquarters and is located only in a virtual environment.

The CBME also has the support of individuals called "guardians". They are Mindful Eating instructors who were invited to collaborate with contents related to the topic and conveyed by the CBME in its website and social media since 2019. After this first year of joint work with the CBME, the guardians became collaborative members, which are those who are invited to act more frequently and effectively in several other topics related to the CBME.

With the expansion of the CBME, the possibility of membership was opened. Affiliated members are not necessarily Mindful Eating instructors, but professionals who identify with the topic and its approach. Affiliation provides some exclusive benefits, especially related to access to the contents and materials on MindfulEating offered by the CBME. Currently, this center is composed of four directors, four collaborating members, two guardians, and 111 affiliated members.

The CBME's organizational structure is horizontal, decentralized, and based on the DragonDreaming collaborative management technology model, whose organizational practice uses the dialogical context through conversational ways and avoids the pyramidal hierarchical model. Such management model seeks to deal with the dialectics of group life, by mobilizing the individual aspirations in favor of a common objective, considering collective intelligence, dialogs, and affective bonds⁽²³⁾.

Another important point of organizations with a horizontal structure among their leaders is the dialog issue, which occurs based on the principle of Non-Violent Communication, consisting of a specific approach of communication appreciated by compassionate "speaking and listening", which supports establishing relationships of partnership and cooperation. Thus, it seeks the distinction between observations and judgments: the distinction between feelings and opinions; needs and strategies; requests and demands⁽²⁴⁾.

Objectives and motivations: love, care, and ethics

Among the main objectives that permeated the creation of a MindfulEating center in Brazil, the need for building a space that was a source of reliable information, fostered by professionals who study the area, built based on international guidelines and good Mindfulness and Mindful Eating practices, and that contemplated both the professional and the general populations.

In contemporary times, there is a situation of "food panic", especially characterized by the pharmaceuticalization of eating, which overcomes its cultural, social, and symbolic aspects. The eating rules, based only on the biological role of food, are the main guidelines of the individuals' food choices, staying out of the references to pleasure, preferences, and eating habits of people⁽²⁵⁾. The frequent practice of going on a diet to reach "health" boosts this purely biological look at eating and at food, which can result in an intense disconnection with the internal signals of hunger and satiety, since the decision of what and how much to eat is transferred to external rules⁽²⁶⁾. In this scene, MindfulEating emerges as a promising alternative to the traditional diet approaches, valuing healthy eating with a focus on rescuing the recognition of internal signals of appetite, and on being aware of the eating patterns, as well as of the body and emotional sensations awaken when eating. In this sense, the diet mindset, so common in our social and academic setting, brings the need for updated research studies and professionals specialized in MindfulEating, so as to sustain the proposals of this approach^(27-30).

According to the TCME, there are crucial points to be worked on in order to ensure the adequate development of the interventions based on MindfulEating. Among them, the following stand out: recognizing the multi-factorial nature of the aspects involving health and well-being; not promoting approaches that bring external control of the eating habits - such as diet practices; not moralizing eating, and not promoting weight and body size stigmas⁽³¹⁾.

Among the objectives of the CBME, the engagement for the training of professionals who wish to become Mindful Eating instructors stands out, or incorporating its concepts in the clinical practice, ethically, safely, and coherently with the good international practices. Thus, the CBME organizes the training sessions based on the Mindful Eating protocols and welcomes the future instructors by promoting contents that foster post-training.

It is believed that the consistency of the intervention protocols based on Mindfulness, which are currently being tested, is essential so that well-supported evidence can be produced. In addition to qualification content for the training of a Mindfulness instructor, these protocols imply a requirement: maintenance and continuity of their development as a professor, important and necessary requirements for the incorporation of the topic in society and in scientific research⁽³²⁾.

The ethical issue applied to the concept of Mindfulness and MindfulEating emerged as an important construction pillar of the CBME's objectives. In the health area context, we have a consolidated structure and an ethical code of professional conduct based on the Hippocratic tradition, founded on the principles of respect for autonomy, of not causing harms, and of beneficence, the latter as a concept of doing good to the other, both in the relationships, especially, and in the professional conducts⁽³³⁾. Such principles are axiomatic and fundamental also for the professionals who work with the service protocols based on Mindfulness, whether they are provided in a hospital setting or not. The responsibility of bringing ethical conduct also relies on the shoulders of each person who chooses to engage as an instructor of Mindfulness-based interventions, hence the need for having serious organizations that act within these principles, aiming at disclosing the topic for society, networking, and adequate training of instructors, by acting a reference center⁽³⁴⁾.

Challenges and future perspectives: seeding, caring, and harvesting

The CBME has been improving its structure along its trajectory, with objectives and perspectives that are being built and matured along the way. During these almost four years of existence, it managed to establish and consolidate itself in Brazil, with Mindful Eating as its main seed. It brought the theme in a serious, ethical way and based on scientific research by creating the website and social media that are frequently fed with quality information; by organizing two international congresses on MindfulEating - with the merit of being the first congress exclusively dedicated to this theme in the world; by organizing two retreats of in-person training, and by training 96 MindfulEating instructors (60 under the Mindfulness-Based Eating Solution-MBES, Eat for Life protocol; and 36 under the Mindful Eating-Conscious Living - ME-CL protocol).

Besides cultivating what has been established so far, there is an interest in improving the scientific content of the CBME with continuing education projects in Mindful Eating, and also in working so that the care in the relationships that permeate the CBME is a priority, with interest in creating a statute to guide the members within the values and essential missions of Mindfulness and Mindful Eating. Making a stance, looking, breathing, and tasting each achievement is also an important process of the CBME, and essential for harvesting good fruit in the future.

There is also interest in bringing to discussion issues that penetrate society in culturally rooted themes, such as issues related to machismo, beauty standards, and places occupied by women in society. The search for a healthy relationship with eating and with the body also passes through these places and, therefore, this conversation is also necessary⁽³⁵⁾.

Conclusion

The creation of the CBME took place at an opportune moment, reflecting the need to have a communication channel for MindfulEating, a very incipient topic in the Brazilian context. Throughout its construction and establishment as an organization, the CBME has carefully and attentively expressed the importance of cultivating Mindfulness skills as a reference center, as professionals, and as instructors trained to perform in the area.

One limitation of this work was not being able to interview all the creators of CBME. However, the data obtained in this research revealed an important milestone for the history of MindfulEating in Brazil, by bringing about a promising area for scientific research and collective health.

The use of protocols based on Mindfulness and Mindful Eating in scientific research is necessary for the theme to grow stronger and stronger as an important resource for health and quality of life.

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