Abstract

Introduction

A personal relationship between the body and food occurs as a product of the contact between the senses and body structures, with the stimuli provided by the environment¹1 Longhurst R, Johnston L, Ho E. A visceral approach: cooking “at home” with migrant women in Hamilton, New Zealand. Trans Inst Br Geogr. 2009; 34(3):333-45.. Food is recognized for building and modulating cultural identity according to the meanings of experiences produced in contact with food²2 Rose G. Researching with visual materials: a brief survey. In: Rose G, organizadora. Visual methodologies: an introduction to researching with visual materials. 4th ed. London: SAGE Publications; 2016. p.1-23.^,33 Santos LAS. Reflexões sobre a tríade corpo, comer e comida. In: Santos LAS, organizadora. O corpo, o comer e a comida um estudo sobre as práticas corporais alimentares cotidianas a partir da cidade de Salvador - Bahia. Salvador: Editora da Universidade Federal da Bahia; 2008. p. 21-45.. Despite the relevance of the theme, it has been little explored, especially from the perspective of the involvement of food in the symbolic and cultural construction of the body³3 Santos LAS. Reflexões sobre a tríade corpo, comer e comida. In: Santos LAS, organizadora. O corpo, o comer e a comida um estudo sobre as práticas corporais alimentares cotidianas a partir da cidade de Salvador - Bahia. Salvador: Editora da Universidade Federal da Bahia; 2008. p. 21-45..

The obesogenic environment⁴4 Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, Bogard JR, et al. The global syndemic of obesity, undernutrition, and climate change: the lancet commission report. Lancet. 2019; 393(10173):791-846. is characterized by excessive stimulation and easy access to the consumption of food with poor nutritional quality. This food environment has unbalanced the connection and regulation of bodily needs, such as hunger and satiety⁴4 Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, Bogard JR, et al. The global syndemic of obesity, undernutrition, and climate change: the lancet commission report. Lancet. 2019; 393(10173):791-846.. Food decision-making taken with reduced time and attention is affected by low reflective capacity, which can contribute to overconsumption⁵5 Provencher V, Jacob R. Impact of perceived healthiness of food on food choices and intake. Curr Obes Rep. 2016; 5(1):65-71.. In this scenario, consumption patterns and values related to the body are disseminated under the aegis of modernization, hedonism, individualism, and the idealization of a socially accepted body³3 Santos LAS. Reflexões sobre a tríade corpo, comer e comida. In: Santos LAS, organizadora. O corpo, o comer e a comida um estudo sobre as práticas corporais alimentares cotidianas a partir da cidade de Salvador - Bahia. Salvador: Editora da Universidade Federal da Bahia; 2008. p. 21-45.^,66 Quittkat HL, Hartmann AS, Düsing R, Buhlmann U, Vocks S. Body dissatisfaction, importance of appearance, and body appreciation in men and women over the lifespan. Front Psychiatry. 2019; 10:1-12., especially for women⁶6 Quittkat HL, Hartmann AS, Düsing R, Buhlmann U, Vocks S. Body dissatisfaction, importance of appearance, and body appreciation in men and women over the lifespan. Front Psychiatry. 2019; 10:1-12..

Previous studies have identified that the body plays a fundamental role in experiences with the world⁷7 McCorquodale L, DeLuca S. You want me to draw what? Body mapping in qualitative research as canadian socio-political commentary. Forum Qual Sozialforsch. 2020; 21(2):1-28. doi: 10.17169/fqs-21.2.3242.
https://doi.org/10.17169/fqs-21.2.3242... , which is known as an embodied(^e(e)Term used in international literature.) experience, such as the experience produced by the body in contact with food. Food mediates these experiences³3 Santos LAS. Reflexões sobre a tríade corpo, comer e comida. In: Santos LAS, organizadora. O corpo, o comer e a comida um estudo sobre as práticas corporais alimentares cotidianas a partir da cidade de Salvador - Bahia. Salvador: Editora da Universidade Federal da Bahia; 2008. p. 21-45., in parallel with the recognition of bodily needs that depend on the level of consciousness and self-knowledge⁸8 Craig AD. How do you feel? Interoception: the sense of the physiological condition of the body. Nat Rev Neurosci. 2002; 3(8):655-66. and are fundamental for the regulation of bodily states⁹9 Herbert BM, Pollatos O. The body in the mind: on the relationship between interoception and embodiment. Top Cogn Sci. 2012; 4(4):692-704.. Consciousness actively participates in the person’s relationship with the world, coordinating decision-making and behavior based on the combination of information received in this relationship¹⁰10 Pereira A Jr. Triple-aspect monism: a conceptual framework for the science of human consciousness. In: Pereira A Jr, Lehmann D, editores. The unity of mind, brain and world. New York: Cambridge University Press; 2013. p. 299-337.. The embodied experience, on the other hand, can modulate decision-making and behavior, mediate the relationship with social norms, and direct food desires and attitudes¹1 Longhurst R, Johnston L, Ho E. A visceral approach: cooking “at home” with migrant women in Hamilton, New Zealand. Trans Inst Br Geogr. 2009; 34(3):333-45.^,1111 Hayes-Conroy A. Feeling slow food: visceral fieldwork and empathetic research relations in the alternative food movement. Geoforum. 2010; 41(5):734-42..

Methods that access the symbolic relationship between the body and food to deepen food consciousness are still scarce in the literature and could be strategic for educational programs¹²12 Hsu T, Forestell CA. Mindfulness, mood, and food: the mediating role of positive affect. Appetite. 2021; 158:105001.. Approaches that use creative-reflective methods¹³13 Futch VA, Fine M. Mapping as a method: history and theoretical commitments. Qual Res Psychol. 2014; 11(1):42-59. and encourage food consciousness⁵5 Provencher V, Jacob R. Impact of perceived healthiness of food on food choices and intake. Curr Obes Rep. 2016; 5(1):65-71.^,1010 Pereira A Jr. Triple-aspect monism: a conceptual framework for the science of human consciousness. In: Pereira A Jr, Lehmann D, editores. The unity of mind, brain and world. New York: Cambridge University Press; 2013. p. 299-337. are potent alternatives. Recognizing the difficulty in capturing the meanings of the symbolic relationship between the body and food through verbal communication, these can be represented by the embodied experience through visual representations such as words, objects, and images¹⁴14 Figueiredo MD, Silva AO. Expressões alimentares em mulheres com obesidade: facetas simbólicas do complexo do comer. Plur Saude Ment. 2020; 9(2):28-33.. The embodied experience is characterized by the generation of data from the representation of the body, which allows the perception of experiences from the perspective of what is sensed and experienced by the body¹⁵15 Gastaldo D, Magalhães L, Carrasco C, Davy C. Body-map storytelling as research: methodological considerations for telling the stories of undocumented workers through body mapping [Internet]. Toronto: University of Toronto; 2012 [10 Ago 2023]. Disponível em: http://www.migrationhealth.ca/undocumented-workers-ontario/body-mapping
http://www.migrationhealth.ca/undocument... . This is what body-map storytelling (BMST) proposes, a visual methodology of qualitative research, which has been applied in several contexts¹⁶16 Gastaldo D, Rivas-Quarneti N, Magalhães L. Body-map storytelling as a health research methodology: blurred lines creating clear pictures. Forum Qual Soc Res. 2018; 19(2):1-26. doi: 10.17169/fqs-19.2.2858.
https://doi.org/10.17169/fqs-19.2.2858... , however, its use is still scarce in the area of food and nutrition.

In the scenario of excessive food stimuli that make human health vulnerable by impacting people’s relationship between the body and food, the importance of recognizing body needs is identified for the balance of decision-making and eating behaviors, especially for women. Therefore, this study aimed to access and explore the recognition of the relationship between the body and food in women as a synthesis of an educational intervention for food consciousness through BMST. We sought to answer the following research question: “How is the relationship between the body and food recognized by women from the perspective of experiences proposed in an educational intervention for food consciousness?”.

Methods

Context

The study was developed and applied as part of the Food and Nutrition Education Program with Sensory and Cognitive Exercises (PESC), a Brazilian educational intervention to promote food consciousness¹⁷17 Palazzo CC, Leghi BE, Pereira A Jr, Diez-Garcia RW. Educational intervention for food consciousness: a randomized study protocol. Nutrition Health. 2022; 28(1):123-9.. The food consciousness approach was based on the Triple Aspect Monism (TAM) theory of consciousness¹⁰10 Pereira A Jr. Triple-aspect monism: a conceptual framework for the science of human consciousness. In: Pereira A Jr, Lehmann D, editores. The unity of mind, brain and world. New York: Cambridge University Press; 2013. p. 299-337., as described above. The PESC aims to strengthen women’s perception of the stimuli provided by the obesogenic environment for food consumption. The intervention consisted of 6 meetings, being 2 for evaluation and 4 for workshops, in which themes such as food desire (workshop 1), food pleasure (workshop 2), and body signs of hunger and satiety (workshop 3) were explored, ending with the record of eating experiences in the body (workshop 4). Details on the development and application of the PESC have been previously published¹⁷17 Palazzo CC, Leghi BE, Pereira A Jr, Diez-Garcia RW. Educational intervention for food consciousness: a randomized study protocol. Nutrition Health. 2022; 28(1):123-9..

Qualitative and theoretical approaches

This study used the BMST with a qualitative research design¹⁵15 Gastaldo D, Magalhães L, Carrasco C, Davy C. Body-map storytelling as research: methodological considerations for telling the stories of undocumented workers through body mapping [Internet]. Toronto: University of Toronto; 2012 [10 Ago 2023]. Disponível em: http://www.migrationhealth.ca/undocumented-workers-ontario/body-mapping
http://www.migrationhealth.ca/undocument... and was cross-sectional. This is because it refers to the fourth workshop of the PESC¹⁷17 Palazzo CC, Leghi BE, Pereira A Jr, Diez-Garcia RW. Educational intervention for food consciousness: a randomized study protocol. Nutrition Health. 2022; 28(1):123-9., a moment for the synthesis of the intervention and a means for recording the consciousness of the eating experiences explored in the intervention on the representation of the body. The means for recording these experiences was by the representation of the food identity and the relationship with food in the BMST. The BMST generation is based on mapping lived experiences of the body through artistic processes¹⁸18 Klein M, Milner RJ. The use of body-mapping in interpretative phenomenological analyses: a methodological discussion. Int J Soc Res Methodol. 2019; 22(5):533-43.. Therefore, stimulates the generation of narratives and the construction of visual representations, doing this through the attribution of meanings¹⁵15 Gastaldo D, Magalhães L, Carrasco C, Davy C. Body-map storytelling as research: methodological considerations for telling the stories of undocumented workers through body mapping [Internet]. Toronto: University of Toronto; 2012 [10 Ago 2023]. Disponível em: http://www.migrationhealth.ca/undocumented-workers-ontario/body-mapping
http://www.migrationhealth.ca/undocument... . The theoretical framework, TAM¹⁰10 Pereira A Jr. Triple-aspect monism: a conceptual framework for the science of human consciousness. In: Pereira A Jr, Lehmann D, editores. The unity of mind, brain and world. New York: Cambridge University Press; 2013. p. 299-337., considers consciousness as a person’s recognition of an experience lived in the world perceived from what it produces in the body, such as sensations (for example body states, such as hunger, and thirst), emotional, cognitive, or perceptual content, or even an event evaluation.

The combination of the BMST and the TAM theoretical framework is useful because the BMST allows the recognition of experiences using the representation of the body¹⁵15 Gastaldo D, Magalhães L, Carrasco C, Davy C. Body-map storytelling as research: methodological considerations for telling the stories of undocumented workers through body mapping [Internet]. Toronto: University of Toronto; 2012 [10 Ago 2023]. Disponível em: http://www.migrationhealth.ca/undocumented-workers-ontario/body-mapping
http://www.migrationhealth.ca/undocument... , a condition considered fundamental by the TAM for raising consciousness as a product of the interaction with the world¹⁰10 Pereira A Jr. Triple-aspect monism: a conceptual framework for the science of human consciousness. In: Pereira A Jr, Lehmann D, editores. The unity of mind, brain and world. New York: Cambridge University Press; 2013. p. 299-337.. Previously¹⁹19 Leghi BE, Palazzo CC, Magalhães L, Diez-Garcia RW. Using body-map storytelling for accessing insights in an educational intervention for food consciousness. Int J Qual Methods. 2022, 21:1-15. the application of the BMST demonstrated its ability to access food consciousness as it was a means of expression and reflection on eating experiences.

Researchers’ positionality and reflexivity

We are a research group formed by Brazilian women that studies the theoretical-methodological interfaces between social and biological sciences in the field of food and nutrition. In this study, the subjectivity of the relationship of women between food and body was accessed and communicated through the production of the narratives by a visual and participatory methodology, the BMST.

Participants

The participant’s recruitment consisted of¹⁷17 Palazzo CC, Leghi BE, Pereira A Jr, Diez-Garcia RW. Educational intervention for food consciousness: a randomized study protocol. Nutrition Health. 2022; 28(1):123-9. (i) the propagation of the research on social media, website, and e-mail related to the Faculty of Medicine of Ribeirão Preto from the University of São Paulo (FMRP-USP); (ii) a telephone interview was conducted with the interesting participants for the application of the eligibility criteria and clarifications about the procedures of the study. From September 2019 to November 2020, nineteen Brazilian women participated in the PESC, comprising the study population recruited based on the PESC eligibility criteria¹⁷17 Palazzo CC, Leghi BE, Pereira A Jr, Diez-Garcia RW. Educational intervention for food consciousness: a randomized study protocol. Nutrition Health. 2022; 28(1):123-9.. Women with difficulty managing body weight (weight gain greater than 5% in the previous year) who reported a desire to improve their relationship with food were selected. Other inclusion criteria were age between 20 and 59 years²⁰20 World Health Organization. Women and health: today’s evidence tomorrow’s agenda [Internet]. Geneva: WHO; 2009 [citado 10 Ago 2023]. Disponível em: https://iris.who.int/handle/10665/44168
https://iris.who.int/handle/10665/44168... and Body Mass Index (BMI) values between 18.5 and 34.9 kg/m² (classification of eutrophy to obesity grade I)²¹21 World Health Organization. Obesity: preventing and managing the global epidemic [Internet]. Geneva: WHO; 2000 [citado 10 Ago 2023]. Disponível em: https://iris.who.int/handle/10665/42330
https://iris.who.int/handle/10665/42330... . Women who used cigarettes, pregnant women, those with dietary restrictions such as celiac disease or diabetes, those using psychotropic medications, and nutrition students or professionals were excluded. The age range and BMI were justified as the purpose of the intervention was to work with food consciousness.

Gender, race, ethnicity, and biological indicators were not considered, because this study aimed to understand the food consciousness of women as an individual experience, accessed by the BMST in the PESC context. Specifically, to understand how the obesogenic environment stimulus for food consumption is lived and internally processed by the participants of the study.

All the women gave Informed Consent for inclusion before participating in the study. Provisions related to consent, confidentiality, and ethical aspects were ensured in all procedures of the study²²22 Guillemin M, Drew S. Questions of process in participant-generated visual methodologies. Vis Stud. 2010; 25(2):175-88..

Data generation

Socioeconomic profile data (age, marital status, education, per capita income)²³23 Associação Brasileira de Empresas de Pesquisa. Critério Brasil [Internet]. São Paulo: ABEP; 2021 [citado 10 Ago 2023]. Disponível em: https://www.abep.org/criterio-brasil
https://www.abep.org/criterio-brasil... , and anthropometric measures such as weight and height, to calculate the BMI (kg/m²), were gathered. Weight was measured using a digital scale (Wiso®), and height was registered using a portable stadiometer (Cescorf®).

The BMST was adapted compared to the traditional application¹⁵15 Gastaldo D, Magalhães L, Carrasco C, Davy C. Body-map storytelling as research: methodological considerations for telling the stories of undocumented workers through body mapping [Internet]. Toronto: University of Toronto; 2012 [10 Ago 2023]. Disponível em: http://www.migrationhealth.ca/undocumented-workers-ontario/body-mapping
http://www.migrationhealth.ca/undocument... , according to a specific protocol¹⁹19 Leghi BE, Palazzo CC, Magalhães L, Diez-Garcia RW. Using body-map storytelling for accessing insights in an educational intervention for food consciousness. Int J Qual Methods. 2022, 21:1-15.. The application of the body map lasted 2 hours and was carried out in small groups of up to 6 participants; however, the construction of the body map was individual. Four researchers were trained for the application and helped the participants with guidance and encouragement for reflection throughout the process. The research team also observed the mapping development for the data analysis. The body map was applied in a large and reserved place, providing adequate space for its development.

Initially, the participants performed a relaxation exercise to connect with the body sensations, received guidance on the activity, clarified any questions, and signed the Consent Form. Based on the first body map construction exercise - body tracing and food identity -, they developed maps based on their body identity and recognition of their relationship with food through embodied representations. Starting from the representation of the body silhouette, in the scaled size of an A3 sheet (297 by 420 mm), the participants were invited to draw their own body in the position that most represented them, to decorate the outline of this body and to assign a pseudonym as a title to represent the body map considering their relationship with food. Next, they were instructed to add physical characteristics of their bodies that allow them to relate to food as a representation of the relationship between the body and food.

Taking the representation of the body as a starting point, the participants initially represented these issues visually through artistic processes (for example, drawings, paintings, and texts), using identical art material kits. Subsequently, these questions were narrated by audio recording using personal cell phones and sent to a private conversation platform with the main researcher using a messaging application (WhatsApp). These narratives were accounted for in minutes based on average for participant’s narratives characterization. Furthermore, they gave meaning to the context represented in the body map and to the visually constructed representations.

Data analysis

The organization and processing of the data were carried out soon after the application of the BMST. The nineteen maps were photographed, and the audio recordings were transcribed. Using the qualitative data analysis software (Atlas.ti, version 9.0; scientific software development GmbH, Berlin, Germany), the images of the photographed maps were inserted, as were the transcripts. The material was filed as visual and narrative representations, respectively. For each participant, a document was created containing the description of the visual representations with the meanings provided by the narrative representations. This process was considered as a first step of analysis by approaching the data generated. Considering that they are different types of communication, although constructed together, the visual and narrative representations were analyzed in an integrated way, using different techniques.

The analysis of the visual representations was inspired by semiology. To understand communication patterns, semiology aims to access the symbols of images based on their meanings⁸8 Craig AD. How do you feel? Interoception: the sense of the physiological condition of the body. Nat Rev Neurosci. 2002; 3(8):655-66.^,2424 Rose G. Semiology: laying bare the prejudices beneath the smooth surface of the visible. In: Rose G, organizadora. Visual methodologies: an introduction to researching with visual materials. 4a ed. London: SAGE publications; 2016. p. 106-46.. To analyze the narrative representations, content analysis was used, in the reflective thematic modality²⁵25 Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006; 3(2):77-101.^,2626 Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Heal. 2019; 11(4):589-97., which uses the generation of themes to understand patterns of meanings. Table 1 presents a summary of the integration of the analyses and describes how the processes were performed. The analyses were developed by 2 researchers involved in the study who compared, discussed, and synthesized all the analysis processes.

The study was approved by the Human Research Ethics Committee of the Hospital das Clínicas of FMRP-USP with the National Research Ethics Commission (CONEP), protocol number 09850919.6.0000.5440.

Results

The median age of participants was 37 years; 47% were single; 79% had completed higher education; and the economic classification was compatible with low income (58%)²³23 Associação Brasileira de Empresas de Pesquisa. Critério Brasil [Internet]. São Paulo: ABEP; 2021 [citado 10 Ago 2023]. Disponível em: https://www.abep.org/criterio-brasil
https://www.abep.org/criterio-brasil... . Concerning physical activity, 74% practiced regularly. Regarding the anthropometric profile and according to the BMI classification²¹21 World Health Organization. Obesity: preventing and managing the global epidemic [Internet]. Geneva: WHO; 2000 [citado 10 Ago 2023]. Disponível em: https://iris.who.int/handle/10665/42330
https://iris.who.int/handle/10665/42330... , 2 participants were eutrophic (median BMI=22.35kg/m²), 12 were overweight (median BMI=27.20kg/m²), and 5 were obese grade I (median BMI= 31.20kg/m²). The audio recordings lasted for an average of 11 minutes per participant.

Table 2 presents the results of the analysis of the representations, according to the themes, subthemes, and codes generated. They were generated by the data communicated meaning patterns as a representation of the BMST exercises (food identity and recognition of the relationship with food). They are presented by level of complexity, from the least to most complex, and represent the recognition of the relationship between the body and food based on forms of self-denomination.

The participants’ narratives, as presented below, are identified with the fantasy name, in parentheses, in reference to the name that each participant self-assigned to represent their BMST.

Theme 1. Identity

For the first theme, identity, the participants expressed the recognition of personal values and personal body characteristics (examples: qualities, how they see themselves from the body shape, references, and relationships that inspired and identified them) using a pseudonym, as well as, how they identified with life experiences according to body posture (examples: ways of positioning themselves, dynamics adopted in life, activities performed and appreciation of qualities). In particular, the color chosen for the outline of the body was a striking form of expression to communicate meaning (Figure 1).

Violet´s body map, representing theme 1, Identity, by codes and respective narratives (see the letters a to d in Table 2): (a) desire for change: “I think the colors purple and violet represent transformation and the desire to change”; (b) standing and fronting: body self-analysis: “I made the outline upright to make it easier to fill in the drawing”; (c) life values, expressed by vibrant colors: “I put glitter around it because I think my mood today is a little more wanting to represent transformation and desire for change, so I put a little bit of purple glitter to show this idea”; (d) appearance characteristics, body structure, and shape: "I made the body contour a little asymmetrical, and the top a little wider because I have broader shoulders; the leg is a little smaller because I have one leg slightly shorter. The elements I put on were hair, eyes, eyebrows, eyelashes, and a little blush, because sometimes I’m a little vain, I like makeup, these things, mainly to identify myself. (Violet)"

Theme 2. Person-world relationship

This theme was represented by the women’s ways of relating to the world, based on their experience with the body and food. This relationship could be directed towards the person, as narrated by the participant who title her body map: Suddenly wide body, slumped shoulders:

She gave meaning to her eating experience based on her subjective relationship with her body – dissatisfaction -, marked by food desire and a body expression – not having a mouth – to express sadness and discontent. The women’s relationship with the world could also be directed toward the world:

She gave meaning to the choice of body posture by the way she moves in life, that is, her experience in the world: attentive and sustained by reality, represented by the experience with the body and the steeping floor.

Theme 3. Temporality

The recognition of the relationship between the body and food was also marked by the period of life. The past, marked by memories, was exemplified by the narrative: “I chose Margarida [body map´s title] because as the representation is about me, I remembered that my mother called me ‘margarida’ when I was a child”. (Margarida)

The present revealed the participants´ views about themselves: “Me for me [body map’s title] is how I see myself, it’s not how I think people see me or how I would like to be seen.” (Tica).

The future was marked by idealizations of how a person should be: “I chose the standing, up-right body position because it is to exemplify how I see myself: a person who needs to have posture needs to be straight and needs to be more serious in certain situations.” (Cristal).

Theme 4. Synthesis: identity and embodied relationship with food

The order of construction of the mapped elements (position – outline – pseudonym), defined the style of the body map, that is, it synthesized the striking aspect to be communicated by it. For example, the body map style that synthesized dissatisfaction had a tone of expression in the body map for excesses, disproportions, and asymmetries of body shape, characterized by the perception of suffering with the body perception. The style directed towards identity was visually highlighted by elements of personal experience and personality. In the style of transcendence, vibrant colors were represented in the drawing without delimiting contours (for example there is no representation of hands and feet), re-producing the expansion of the meanings of life. The body map in Figure 2 exemplifies the reflective style, expressed by the narrative:

She represented the need for connection with herself through her body posture, reproducing the way of relating to food. Figure 2 also shows embodied representations of the relationship with food. The centrality occupied by the mind in the regulation of bodily functions was represented (Figure 2, letter e). Manifestations from organs (Figure 2, letter f) referred to vitality by maintaining bodily functions through food. They also referred to the process of food entrance into the body, as narrated by this participant: “I circled the neck more towards the throat. Because it is through there [throat] that food comes in contact with my body, externally to internally, right?!” (Tica).

Sensory aspects manifested the strength of sensory appeals for food desire and pleasure: “I eat with my eyes. The first reaction I have when I see a favorite dish is my eyes start shining [emphasis], that feeling of my mouth watering. And I have a feeling of pleasure, you know?!” (Margarida).

Nevertheless, some participants focused on the moment when the person contact with food before starting eating: “The eyes, because first I believe that we eat a lot with our eyes. First attraction, then smell, then taste” (Eth, body and health).

Others highlighted the contact with food as the flavor through taste (Figure 2, letter g): “The mouth because it’s the way we eat” (Alice).

The participants also integrated the expectations before eating with the experience of eating: “I prepare food with my hands and with them put it in my mouth” (Maturity).

The aspects before eating were marked by sight and smell; and those of contact, by taste, touch, and hearing. Finally, the subjective relationship with the body identified meanings about weight: “Being a little overweight, right?! It shows that I have had a good relationship with food, that I have been eating a lot” (The liberty).

Also, about the systemic emotional state: “I used a smiling mouth to represent my relationship with food. Because I consider myself a happy person. Food for me is something that brings me a lot of joy, a lot of satisfaction, a lot of pleasure” (Human).

Fernanda’s body map, representing theme 4, synthesis: identity and embodied relationship with food, through codes and respective narratives (see the letters e to g in Table 2): (e) mind: "The brain is what controls all the functions, all the organs, and that sends you the feeling of satiety [...] and that has everything to do with your relationship with food, what you think about food, your emotions [...] that’s why I made it right in the center and with glitter to draw more attention. (Fernanda)". (f) organs, and physical health: "I also drew attention to the stomach with the sequins, because it is very important, it has everything to do with food, digestion, and feelings of satiety and hunger. (Fernanda)". (g) sensory aspects: the narrative was exemplified in the text.

Discussion

The BMST effectively accessed and represented the recognition of the relationship between the body and food of women by forms of self-denomination, integrating personal experiences with those experienced in the intervention, the PESC. Nuances were represented regarding desires and needs, limitations, how they identified themselves through body shape and posture, as well as food demands. The participants reflected on what inspired them and what was important, including lessons learned with the PESC workshops. Therefore, the BMST allowed access to self-consciousness and the implications of conscious aspects in the relationship between the body and food in the interaction of women with the world.

The participant’s socioeconomic characteristics, represented by a high level of education and a social class with lower economic power, could be explained by the means utilized by this study for participant recruitment in the context of a University (FMRP-USP).

The integration between forms of self-denomination and experiences in the world was marked by the active participation of the body in the unfolding of the relationship with food. We propose that there was the encouragement of somatic representation¹¹11 Hayes-Conroy A. Feeling slow food: visceral fieldwork and empathetic research relations in the alternative food movement. Geoforum. 2010; 41(5):734-42., which assumes the participation of the body as a central element in the development of the senses involved in the lived experiences, and, therefore, in the repercussion of behaviors that involve sensations, emotions, and perceptions²⁷27 Anderson B. Becoming and being hopeful: towards a theory of affect. Environ Plan D Soc Space. 2006; 24(5):733-52.. Regarding the theoretical framework applied, TAM¹⁰10 Pereira A Jr. Triple-aspect monism: a conceptual framework for the science of human consciousness. In: Pereira A Jr, Lehmann D, editores. The unity of mind, brain and world. New York: Cambridge University Press; 2013. p. 299-337., consciousness is produced when the person identifies the meanings of experiences lived in the world through the body, influenced by the sociocultural context²⁸28 Carvalho MCVS, Luz MT. Práticas de saúde, sentidos e significados construídos: instrumentos teóricos para sua interpretação. Interface (Botucatu). 2009; 13(29):313-26. doi: 10.1590/S1414-32832009000200006.
https://doi.org/10.1590/S1414-3283200900... .

The importance of explaining the meanings of the position, outline, and pseudonym chosen by the participants referred to the constitution of women’s identity. The elements mapped in the BMST are recognized for setting limits between the public (world) and private (person) space²⁹29 Sweet EL, Escalante SO. Bringing bodies into planning: visceral methods, fear and gender violence. URBAN Stud. 2015; 52(10):1826-45.. Authors propose that the skin is an expression of the body defining the relationship with the world³⁰30 Ferreira FR. A produção de sentidos sobre a imagem do corpo. Interface (Botucatu). 2008; 12(26):471-83. doi: 10.1590/S1414-32832008000300002.
https://doi.org/10.1590/S1414-3283200800... ^,3131 Lupton D. Theoretical perspectives on food and eating. In: Lupton D, organizadora. Food, the body and the self. 2a ed. London: SAGE Publications; 1998. p. 6-36.. The throat is considered a means of an inside entry of food into the body, which reveals the intimacy of the food-body relationship as food becomes viscerally part of the body³²32 Counihan CM. The body as voice of desire and connection in Florence, Italy. In: Counihan CM, organizadora. The anthropology of food and body: gender, meaning, and power. Nova York: Taylor & Francis; 1999. p. 178-94.. Other authors³³33 Guiné RPF, Ferrão AC, Ferreira M, Correia P, Cardoso AP, Duarte J, et al. The motivations that define eating patterns in some Mediterranean countries. Nutr Food Sci. 2019; 49(6):1126-41., described that food manifests people’s identity through the symbolic content it acquires throughout life. We suggest, therefore, that the elements built in the BMST probably performed these functions, for example, representing how their postures expressed how they see themselves in the world, and how the experiences lived in the context of their lives awakened continuous and insatiable desires associated with body dissatisfaction.

The role of individual factors in the process of changing lifestyle, particularly in promoting health-oriented eating practices, has been explored by other studies³⁴34 Brennan L, Klassen K, Weng E, Chin S, Molenaar A, Reid M, et al. A social marketing perspective of young adults’ concepts of eating for health: is it a question of morality? Int J Behav Nutr Phys Act. 2020; 17(1):44.^,3535 Morgan C, Wildt G, Prado RBR, Thanikachalam N, Virmond M, Riley R. Views and experiences of adults who are overweight and obese on the barriers and facilitators to weight loss in southeast Brazil: a qualitative study. Int J Qual Stud Health Well-being. 2020; 15(1):1-14.. These studies highlighted the impact of environmental factors, such as cost, time, and publicity, on people’s dilemma between succumbing to desires and/or pleasures versus alignment with health practices. In our study, we observed these same dilemmas such as the recognition of how these factors became part of the person (processed and internalized by them), whether by surrendering to appeals and desires or by suffering their contradictions with other aspects. The consciousness of the influences surrounding food choice⁵5 Provencher V, Jacob R. Impact of perceived healthiness of food on food choices and intake. Curr Obes Rep. 2016; 5(1):65-71.^,3636 Palazzo CC, Leghi BE, Diez-Garcia RW. Food consciousness intervention improves interoceptive sensitivity and expression of exteroception in women. Nutrients. 2022; 14(3):1-12. can represent an alternative for the prevention and treatment of obesity, in food and nutrition interventions based on lifestyle changes.

Temporality, another finding of this study, indicated the recognition of the relationship between the body and the food according to the period of life, as future projections in favor of changes, as narrated by a participant when mentioning her posture. Some authors³⁷37 Mantau A, Hattula S, Bornemann T. Individual determinants of emotional eating: a simultaneous investigation. Appetite. 2018; 130:93-103. defined temporal orientation as a health influencer, as it is a sign of what is recognized and valued, aspects emphasized by the participants of our study. These authors³⁷37 Mantau A, Hattula S, Bornemann T. Individual determinants of emotional eating: a simultaneous investigation. Appetite. 2018; 130:93-103. associated future projections with health practices as the person will be anticipating potential consequences. Conversely, the association with current projections is related to the need for momentary satisfaction, regardless of health consequences. It seems to us, therefore, that projections can help the identification of health influences related to food through the recognition of what is recognized and valued by the person.

The participants also recognized the key aspects that synthesized the body’s and food’s relationship. They demonstrated how an aspect of identity (for example dissatisfaction with the body) intensified the way of relating to food (for example seeking desire and pleasure in food) or defined it (for example meditation as an indication of a connection with herself and food awareness). It is suggested that the individual’s perceptive and cognitive development is integrated with bodily experiences⁷7 McCorquodale L, DeLuca S. You want me to draw what? Body mapping in qualitative research as canadian socio-political commentary. Forum Qual Sozialforsch. 2020; 21(2):1-28. doi: 10.17169/fqs-21.2.3242.
https://doi.org/10.17169/fqs-21.2.3242... ^,3030 Ferreira FR. A produção de sentidos sobre a imagem do corpo. Interface (Botucatu). 2008; 12(26):471-83. doi: 10.1590/S1414-32832008000300002.
https://doi.org/10.1590/S1414-3283200800... . Furthermore, the communication of these experiences requires the development of content based on the expressions of the representation of the body, to integrate individual identity through body experiences¹³13 Futch VA, Fine M. Mapping as a method: history and theoretical commitments. Qual Res Psychol. 2014; 11(1):42-59.. Therefore, how the participants in this study recognized, from the representation of the body, getting in touch, internalizing, and giving meaning to food experiences that are present in the world, may indicate that food can be an expression of this relationship with the body.

The sensory and metabolic aspects in the process of food choice and consumption from a biological perspective are well described in the literature³⁸38 Boesveldt S, Graaf K. The differential role of smell and taste for eating behavior. Perception. 2017; 46(3/4):307-19.. However, little is known about the sensorial and metabolic aspects from the subjective and embodied perspective³3 Santos LAS. Reflexões sobre a tríade corpo, comer e comida. In: Santos LAS, organizadora. O corpo, o comer e a comida um estudo sobre as práticas corporais alimentares cotidianas a partir da cidade de Salvador - Bahia. Salvador: Editora da Universidade Federal da Bahia; 2008. p. 21-45.^,77 McCorquodale L, DeLuca S. You want me to draw what? Body mapping in qualitative research as canadian socio-political commentary. Forum Qual Sozialforsch. 2020; 21(2):1-28. doi: 10.17169/fqs-21.2.3242.
https://doi.org/10.17169/fqs-21.2.3242... . The present study demonstrated the participants’ recognition of these aspects, from forms of detection by the senses as initial contact with food, through processing by the organs, to the subjective elaboration of the relationship between the body and the food. We reinforce the possibility of the representation of conscious aspects¹⁰10 Pereira A Jr. Triple-aspect monism: a conceptual framework for the science of human consciousness. In: Pereira A Jr, Lehmann D, editores. The unity of mind, brain and world. New York: Cambridge University Press; 2013. p. 299-337. considering the recognition of experiences from the perspective of how the women experience and recognize the constructed phenomena. The present study demonstrated that the BMST was an efficient tool for the recognition of the relationship between the body and the food of these participants and, therefore, enabled reflection to deepen food consciousness, from the perspective of the educational intervention along the lines of the PESC¹⁷17 Palazzo CC, Leghi BE, Pereira A Jr, Diez-Garcia RW. Educational intervention for food consciousness: a randomized study protocol. Nutrition Health. 2022; 28(1):123-9..

We considered as limitations of the study (i) homogeneous population, which may not reflect the sociocultural reality of the population groups; (ii) not include other social indicators for a better understanding of the population of the study. We emphasize the necessity of other studies to analyze the subjective dimension in specific social groups, and also, the need to apply this study in other contexts, such as other regions of Brazil and other countries, as well as in other population groups, whether due to different health conditions, gender, age, and sociocultural aspects.

Conclusions

This study was able to access and explore the recognition of the relationship between the body and the food of women by forms of self-denomination as a synthesis of an educational intervention based on food consciousness. Through body-map storytelling, aspects of identity, person-world relationship, temporality, and synthesis of identity and embodied relationship with food, marked the conscious recognition of the relationship between body and food. Body-map storytelling is an innovative and effective tool to access and communicate the involvement of food in the symbolic construction of the body. This study contributed as a strategy for educational programs that seek to strengthen women’s reflection and health on how the obesogenic environment can affect the relationship between the body and food.

Acknowledgment

The authors would like to thank institutions that supported the research and people who collaborated with the study but did not meet the authorship criteria: we thank Dr. Alfredo Pereira Junior, Gabriela Batista Ribeiro Mendonça, and Homero Munaretti, for their contributions to the study and all women who participated in the study. We also thank the Postgraduate Program in Internal Medicine at the Faculty of Medicine of Ribeirão Preto at the University of São Paulo (FMRP/USP) for their support in translating the article into English. BEL thanks the National Council for Scientific and Technological Development (CNPq) for the study grant [grant number 168801/2018-3]. RWDG and LM thank CNPq for the productivity grants [grant number 303194/2018-9 and 303037/2018-0].

References

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