INTRODUCTION
Mindfulness-Based Cognitive Therapy (MBCT), along with Acceptance and Commitment Therapy (ACT) and Dialectical Behavioral Therapy (DBT), is considered one of the third-wave cognitive behavioral therapies in the field of psychotherapy [1]. It is a modified form of cognitive therapy that incorporates mindfulness practices [1,2]. Kabat-Zinn, widely regarded as the founder of ‘mindfulness’, drew inspiration from Buddhist traditions and philosophy and sought to integrate these principles into treatment. He emphasized the importance of open-hearted, moment-to-moment, and non-judgmental awareness as the core therapeutic elements of mindfulness [3]. Mindfulness is applied across a range of therapies, extending beyond CBT, and its principles are gaining widespread attention for their effectiveness in reducing stress, alleviating symptoms of depression and anxiety, managing pain, and controlling various mental health conditions such as eating disorders and post traumatic stress disorder (PTSD) [4,5].
One of the evolving applications of mindfulness is mindful eating. Emerging in the late 1990s, Kristeller and Hallett introduced a mindfulness-based program for patients with binge eating disorders [6]. The mindful eating program includes processes such as focusing on the sensory properties of food, observing one's cravings, thoughts, and emotions, and the acceptance of cravings and decentering, highlighting the core principles of mindfulness [2]. The mindful eating program has been shown to enhance satiety and reduce the frequency of self-loathing and reward-centered emotionally driven eating behaviors [2]. In addition, it is effective in preventing obesity and promoting healthier eating habits by fostering a more positive, controlled, and enjoyable relationship with food. As a result, mindful eating is used in the treatment of various binge eating disorders and obesity [7,8].
Thus, the application of mindful eating is on the rise in efforts to promote health and well-being. However, the concept of mindful eating within the healthcare context has generated significant confusion due to the absence of clear explanations and persistent ambiguity. In particular, assessment tools like Mindful Eating Questionnaire (MEQ) [9], Mindful Eating Scale (MES) [10], Mindful Eating Behaviour Scale (MEBS) [11], Mindful Eating Inventory (MEI) [12], and Four Facet Mindful Eating Scale (FFaMES) [13] have been criticized for not clearly reflecting the elements of mindful eating or for failing to fully incorporate and measure the core principles of mindfulness. This highlights the limitation that arises from the vague and subjective definition of the mindful eating concept [14,15].
Several definitions of mindful eating have been proposed over time. Framson et al. (2009) defined mindful eating as "non-judgmental awareness of physical and emotional sensations associated with eating" [9]. Shapiro (2009) described it as "the awareness that arises out of intentionally attending in an open and discerning way to whatever is arising in the present moment" [16]. Mantzios (2021) defined it as "the sustained attention to a sensory element of the eating experience and a non-judgmental awareness of thoughts and feelings that are incongruent to the sensory elements of the present eating experience" [15]. However, these definitions simply list the domains or characteristics of mindful eating. The lack of a consensus on the definition of mindful eating in healthcare has led to various conceptual and methodological challenges, negatively impacting the development of the assessment tools discussed earlier [2,15,17].
Mindful eating (or Mindfulness), rooted in Buddhist philosophy and meditation practices, has increasingly been integrated into the sphere of mental health services [3]. According to Rodgers' evolutionary view, concepts are dynamic and context-dependent rather than static and inherent truths. As a concept gains ‘significance’, its ‘use’ and ‘application’ expand. Even if the expression remains the same, various definitions emerge depending on the field of study [18]. Therefore, in order to resolve the ambiguity surrounding the definition of mindful eating in healthcare, it is crucial to identify its key attributes and provide a clear explanation of the concept. In recent years, mindful eating has been increasingly utilized in healthcare, including the fields of nursing and medicine, and non-pharmacological treatments have gained more attention in the treatment of patients with eating disorders, where no clearly defined drug treatment guidelines exist [19]. The importance of new non-pharmacological interventions, including mindful eating, is expected to grow in the future. This trend holds important implications for nursing practice. Thus, the discovery of effective nonpharmacological interventions can be applied across diverse patient groups and become a blue ocean for nursing roles and interventions.
Therefore, this study aims to establish the concept and attributes of mindful eating in healthcare, which has recently gained attention, and to propose a clear definition that takes its context into consideration. This will serve as the first concept analysis of mindful eating, contributing to the advancement of the nursing discipline in the future.
METHODS
According to Rodgers' evolutionary view, concept analysis focuses on identifying the most up-to-date knowledge regarding how a concept is currently used and clarified, emphasizing its practical application rather than adhering to strict rules. This inductive approach allows the study to identify the concept. The process begins with the collection of data to gain a comprehensive understanding of the concept followed by a thorough analysis and interpretation of the collected data.
The concept analysis process, according to the evolutionary view, begins with identifying ‘the concept of interest and associated expressions (if appropriate, including surrogate terms).’ The next step is to ‘Identify and select an appropriate realm (setting and sample) for data collection’. Following this, data is collected based on the concept’s contextual basis of the concept, including interdisciplinary, sociocultural, and temporal variations (Antecedent and Consequential Occurrences). Finally, after data analysis, the process concludes by identifying implications and generating hypotheses for further development [18].
The data collection process to comply with these steps is as follows (Figure 1).
PubMed and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) were selected as the primary databases for data collection, retrieving a total of 879 articles - 724 from PubMed and 155 from CINAHL. Though the research did not limit the disciplines, the overall research focused on healthcare fields such as medicine and nursing. The search term used in both databases was ‘mindful’ and ‘eating’, and ‘health or healthcare or health science or medical or nursing', allowing for comprehensive data retrieval across a broad spectrum. Saturation was achieved by reviewing all data retrieved from the initial collection. No restrictions were set on the year of publication, and only articles written in English were included. After removing 580 duplicate articles, 291 full- text articles were reviewed. Of these, 218 were excluded for the following reasons: 198 did not exhibit any attributes according to the researcher's criteria, 8 lacked original data, 3 were not in English, and 9 dealt with unrelated concepts such as ‘mindful feeding’, ‘mindful drinking’, and ‘mindful eco-wellness’. The final sample for analysis consisted of 81 articles (Appendix 1). Analyzing the final sample, data representing each attribute were extracted as well as the antecedents and consequences.
This study was conducted by researchers, all experts in mental health care and nursing with extensive practical experience and diverse research accomplishments. Participating researchers collectively analyzed the data and shared their findings throughout the process. In cases where opinions differed, additional input was sought from a third-party expert with methodological expertise who was not directly involved in the research. This approach was implemented to minimize potential personal biases during the research process.
RESULTS
In this section, the researcher presents the results of analyzing the concept of ‘mindful eating’ using Rodgers' evolutionary concept analysis (Figure 2). The results are explained in the following order: Antecedents, Attributes, and Consequences
1. Antecedents
Antecedents are events or incidents that cannot be attributed and appear before a concept occurs. In other words, they are the prerequisites for the emergence of the concept, rather than the concept itself [20].
1) Response to cravings
Mindful eating can be understood as an act that begins with food cravings. These cravings are divided into internal and external cues. Internal cues refer to pure hunger and the satiety that motivates eating, while external cues refer to emotional reactions, such as eating to reduce stress or dieting. The key is to notice what cues triggers the urge to eat [2,6,8]. Therefore, the goal of mindful eating is to make eating decisions based on physical signals like hunger (internal cues) and to distance oneself from emotional responses (external cues) by recognizing them as separate events [2,7].
2) Voluntary will
Mindful eating is a practical action and process of decision-making that follows a new approach to transforming eating habits into a healthier form. Therefore, beyond theoretical understanding, the participant's voluntary will is greatly emphasized. Specifically, this reflects an effort to voluntarily engage in one’s health management, reject assumptions related to diet culture, and enhance self-control [2,14,21]. In essence, mindful eating is a participatory activity where individuals make conscious, subjective decisions, focusing on their thoughts, emotions, and sensory experiences, rather than merely on the act of eating and digesting food.
2. Attributes
Attributes are the core and result of concept analysis. Like diagnostic criteria in medicine, they are the characteristics that distinguish a concept from other concepts that are either completely different or closely related. In other words, they are a set of defining characteristics, and these attributes alone should sufficiently explain a description of the concept [20].
1) Concentration to food
This attribute reflects the characteristic of ‘paying attention to the moment-to-moment’, a key element of mindfulness. Rather than reacting to or altering the thoughts, sensations, emotions, or impulses that arise during eating, mindful eating emphasizes observing and experiencing the act of eating in the present moment. In other words, mindful eating focuses on being fully present during the moment of eating food [2,7,22]. To enhance this focus, activities are included to remove external distractions, like smartphones or television, to allow individuals to concentrate on their own experiences, such as the taste, smell, and chewing texture of food [9,14,17,22]. Additionally, savoring the food and appreciating its sensory qualities, rather than merely satisfying hunger, can increase positive emotions and heighten awareness of how food affects one’s emotions. This, in turn, may encourage choosing healthier options [2,17,22].
2) Sustained attention to self
Paying sustained attention to oneself involves being mindful before, during, and after eating, and remaining aware of sensory experiences, as well as physical and emotional changes [2,6,8,22]. Unlike the first attribute (Concentration on food), which focuses on the food itself, this process focuses on internal changes through food. It involves deep selfreflection, recognizing eating habits and patterns, and identifying the cues that trigger eating, along with the thoughts and emotions that arise during the process. This includes not only awareness of food-related sensations during eating, but also the recognition of gradually increasing satiety and fullness signals, prompting one to stop eating [8,22]. Furthermore, reflecting the principle of mindfulness, it involves the element of ‘decentralization’, or the ability to let go of thoughts and emotions that arise during a meal, treating them as events separate from oneself and not clinging to them [2,7].
3) Self-regulation
Mindful eating can be viewed as an adaptive regulatory process that applies mindfulness principles to enhance self-regulation [2,17,21]. Mindfulness-based eating awareness training (MB-EAT) is designed to improve self-regulation of body weight and eating habits through traditional mindfulness meditation techniques such as raisin meditation or guided meditation [23]. This ranges from reducing the frequency and intensity of cravings that trigger emotional eating, assessing hunger and satiety cues, and making food choices, to slowing eating pace, reducing portion sizes, and eating methods. It also includes all decisions made to minimize distractions while eating [8,14,17,22]. In conclusion, self-regulation is a key attribute of mindful eating. It is a self-regulation activity that sets happiness as a longterm goal rather than an immediate gratification through changes in healthy eating habits.
4) The pursuit of pleasure
This attribute embodies the non-judgmental or nonevaluative characteristic, which is central to mindfulness. In mindful eating, a non-judgmental attitude means noticing various thoughts and emotions that arise while eating without reacting to them [2,7,23]. This is especially relevant when addressing emotions such as guilt, boredom, or anxiety. Mindful eating encourages an accepting, tolerant, and non-judgmental observation of one’s experience [6,7,21]. The reason for emphasizing this attitude is that mindful eating aims to satisfy one's physical needs and the consequent pleasure derived from eating, without judgment or evaluation [22]. Therefore, mindful eating is not about dieting or weight loss, but about fulfilling desires and enjoying the sensations related to food intake, pursuing the pleasure of the eating experience itself.
3. Consequences
Consequences refer to events or incidents that occur after the concept is created. In other words, they are the specific phenomena that appear as a result of the occurrence of a concept [20].
1) Changes in eating habits
Modern individuals often eat mindlessly, whether in front of the television or in response to emotions. Eating habits are behaviors that develop over time, becoming automatic or ingrained through specific patterns. Mindful eating serves as a therapeutic intervention aimed at recognizing and gradually altering these established daily eating habits and patterns [8,17,22,23]. These changes can slow the pace of eating, increase the time between bites, and reduce overall food intake as satiety gradually grows [22]. Additionally, it can be applied to individuals with eating disorders, by improving problematic eating behaviors (desensitizing hunger and satiety cues), alleviating stress-related digestive disturbances, reducing binge eating, and halting compulsive behaviors (overeating) [6,8,21].
2) Physical health
Mindful eating causes a chain of positive health effects resulting from changes in eating habits. The intervention can lead to a reduction in body mass index (BMI) and calorie intake, aiding in weight management and obesity prevention. Moreover, it may promote physiological improvements, such as better glycemic control in diabetic patients [2,8,14]. These benefits are significant, and mindful eating is now widely used for a variety of patients with obesity, eating disorders, and binge eating [8,21,23].
3) Emotional health
In addition to improving eating habits and physical health, mindful eating enhances emotional well-being. Specifically, it has been shown to reduce negative emotions and stress, like depression, anxiety, and guilt. It can also improve one's negative body image, which is often cited as a major cause of eating disorders [2,6,21]. This effect is partly due to the element of self-compassion inherent in mindfulness, which fosters the awareness that one is not alone in their struggles, offering resilience and protection [21].
4. Definition of 'Mindful Eating'
The term ‘mindfulness’, which can be considered the etymology of mindful eating, was defined by Kabat-Zinn as “the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment by moment"[3]. Unfortunately, the definitions of ‘mindful eating’ proposed by various scholars closely mirror this concept [9,15,16]. This study aimed to address this problem and offer a more practical definition that integrates elements of mindfulness with therapeutic eating. Through the analysis, four core attributes were identified. According to Rodgers and Knafl (2000), concepts can be defined by a series of identified attributes. Based on the findings of this study, ‘mindful eating’ can be defined as the process of concentration on food, sustained attention to self, and practicing self-regulation for the pursuit of pleasure.
DISCUSSION
The researcher conducted a comprehensive analysis of a large body of literature and identified several key concepts related to ‘mindfulness.’ Common keywords such as ‘non-judgmental (or non-evaluative),’ ‘attention,’ ‘awareness,’ ‘present-moment,’ ‘acceptance,’ and ‘compassion’ were consistently mentioned as core attributes of mindfulness [2,3,7]. The challenge, however, lies in the fact that many scholars defining ‘mindful eating’ have utilized these same attributes of mindfulness, making the definition of mindful eating not much different from mindfulness itself. As a result, the concept of mindful eating remains abstract and is subject to varying interpretations by different scholars, with no clear consensus being established [14,15,17]. This ambiguity has created challenges in determining whether commonly used assessment tools [9-13] are measuring mindful eating or general mindfulness [14,24].
To address this issue, the goal of this study was to resolve the ambiguity and present attributes at a more specific level to distinguish mindful eating from mindfulness. The study concludes that ‘mindful eating' is the process of concentration on food, sustained attention to self, and practicing self-regulation for the pursuit of pleasure. This definition is supported by four attributes (Concentration on food, Sustained attention to self, Self-regulation, Pursuit of pleasure). Additionally, the study identifies two antecedents (Response to cravings, Voluntary will) and three consequences (Changes in eating habits, Physical health, Emotional health). For the results to be meaningful and practically applicable, each attribute needed to balance characteristics of both ‘eating behavior’ and ‘mindfulness’. For example, the core element of mindfulness-focusing on the present moment, paying attention to internal and external cues, focusing on the five senses-is reflected throughout the eating process. So, the study tried to distinguish the object as the material (food) from oneself. Furthermore, the attributes of ‘selfcompassion,’ ‘acceptance,’ and ‘non-judgment' help to release rigid standards and values related to eating, fostering the enjoyment that can be derived from eating behaviors. All these actions are part of a self-directed decision-making process aligned with the tenet of mindfulness.
Another key finding from the data analysis is that 'intuitive eating' can be identified as a related concept to mindful eating. A related concept shares some, but not all, of the attributes of the researcher’s concept of interest. Identifying related concepts helps to expand the scope of understanding and clarifies the defining attributes of the primary concept [18]. Given the longstanding ambiguity surrounding the definition of mindful eating, these two concepts have been applied interchangeably in various studies and assessment tools, causing much confusion [8,24]. Specifically, the two concepts have many similar attributes in that they aim to improve healthy eating habits rather than dieting. While both mindful eating and intuitive eating focus on inner change, the difference lies in that intuitive eating does not incorporate mindfulness practices such as meditation or non-judgment [8,25].
The strength of this study lies in its attempt to address the long-standing debate over the unclear definition of mindful eating, as highlighted in the introduction [2,17]. Based on the findings, the researcher proposes several additional suggestions. First, it is essential to revisit the concept and test whether the proposed attributes can reflect the actual phenomena. This effort can serve as an important clue for developing tools that can precisely measure mindful eating, ultimately improving communication among healthcare professionals. Second, reviewing the literature revealed that there was uncertainty about the effectiveness of mindful eating. While numerous randomized controlled trial (RCT) and meta-analysis studies have been conducted, results on the treatment of eating disorders and weight management varied depending on the study design and methods. Notably, no studies directly observed changes in eating habits as a result of mindful eating interventions [2]. Furthermore, there is ambiguity about whether the changes in physiological indicators were dependent variables caused by the mindfulness intervention or were the result of altered eating habits. While mindful eating clearly follows mindfulness principles, its direct correlation with the relevant domain or traits is unclear [8]. Therefore, it may be premature to draw definitive conclusions about mindful eating interventions, despite their growing popularity [2,8,25]. Follow-up studies employing diverse methodologies will be needed in both research and clinical practice. Third, the effects regarding the children target were inconsistent across the reviewed literature [2]. Given that childhood is a critical period for the development of eating habits, a broader range of studies targeting this young population is needed. Finally, non-pharmacological treatment methods are increasingly emphasized in mental health care, and the importance of mindful eating is expected to grow. Nurses, who have the closest contact with a wide range of patients in both hospital and community settings, are in a unique position to implement these interventions to achieve positive outcomes. Therefore, further research on intervention methods utilizing mindful eating in various healthcare settings is necessary.
CONCLUSION
This study was conducted to clarify the attributes of mindful eating and provide a comprehensive definition of the concept. When synthesizing the literature, ‘mindful eating’ was a phenomenon that occurred only when there was a response to cravings induced by food and voluntary participation. In addition, it was a task of maintaining focus on food and oneself, controlling external distractions, and paying attention to internal changes, and it could be understood as an act to pursue the goal of pleasure. In this way, an individual can obtain physical and emotional health through changes in eating habits. Through data analysis, the researcher identified not only the core attributes but also the antecedents, consequences, and related concepts of mindful eating. Therefore, the study defined mindful eating as ‘the process of concentration on food, sustained attention to self, and practicing self-regulation for the pursuit of pleasure’. The difference between the results of this study and previous literature is that the results of this study are more specific and are more practically applicable. This is significant in that it improves the level of abstraction which was a problem in the past. These findings are expected to help resolve previous debates surrounding the unclear definition and contribute to reaching a general consensus. Therefore, if various follow-up studies are conducted based on these data, the level of evidence for the therapeutic use of mindful eating will be further improved. As mindful eating becomes more established, it has the potential to be widely adopted as an effective non-pharmacological intervention, offering valuable alternatives in healthcare practice.
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