Isabel Azevedo
Porto, Portugal

In the days when human time was organized differently and every hour had its meaning, meals were community events, mostly family events, where people met to socialize as well as dine. Someone took the task of preparing a meal seriously, paying attention to details, with dedication and without hurry. Feasts and simple meals alike were prepared in this manner, eliciting a feeling of convivial ambience and respect.

The habit of eating together, an early characteristic of all human life, persists in people living according to ancestral traditions and across places and cultures.^1,2 It has been eroded by the world of finance and competition, ambition and individualism, leading to more people no longer having a fixed time or place for meals, let alone knowing how to cook. A strange evolution indeed, since modern science and technology should have reduced the time needed to run the economy! These advances should have given us time to contemplate, devote ourselves to others, cultivate, and enjoy life. Philosophers of our time such as Agostinho da Silva in Portugal³ and Edgar Morin in France⁴ have tried to turn people’s attention to this point and make them lead better lives.

Since the dawn of history, society, and religion in particular have prescribed and regulated eating habits, substituting cultural traditions for the primeval instinct. Eating became a socio-cultural event, behavior at the table an important marker of civilization,² and the use of eating utensils led to behavior rules to which civilized people conformed. These rules prescribed a regular time for the meal, where to sit at the table, when to help oneself to food, when to start eating (not before the others), taking small bites (for aesthetic reasons and allow conversation), and when to finish (neither too much ahead nor too much after the other dinners).

When people live by these traditions, eating becomes an important event of the day, leaving no anxiety, no dilemma about what to eat,⁵ no need to weigh calories, and no likelihood of eating too much. There is control, by the person who chooses the menu and decides on the size of the portions, and by the others present at the table who do not feel or think they are being controlled. They enjoy the meal in company, eat slowly, and become naturally and easily satiated in a social manner. Eating in community at fixed hours favors slow eating through the observation of etiquette and participation in conversation.^6-10 Eating slowly affects how much food is eaten.¹¹

Unfortunately, modern eating habits and lifestyles bear little resemblance to ancient rituals, resulting in an epidemic of obesity and metabolic syndrome. Some researchers have proposed alternate causes to obesity¹² beyond the two most prominent factors, food and physical activity. Indeed, there are many more elements to consider, including chronic stress, another characteristic of the modern condition.^13-15 Yet, despite comprehensive research efforts, hundreds of published papers, and multiple recommendations, the problem persists.

One of the underlying causes may be that people have simply forgotten how to eat healthfully. A myriad of theories concerning diet and nutrition have been created with new scientific discoveries. One such proposition, nutritionism, holds that the value of food can be reduced to its individual nutrients.¹⁶ This theory led to rapidly changing, and sometimes contradictory, advice from experts: consume less fat, fewer carbohydrates, and more or less protein—depending on the proponent. The resulting confusion, after the abandonment of traditional eating patterns in favor of more “scientific” approaches to eating, left people worse off than before.

This is especially ironic, as one traditional diet, the so-called Mediterranean diet, has gained credence in some scientific circles.^17,18 This diet, which is comprised of olive oil, nuts,¹⁹ wine,^{20, 21} fresh fruits, vegetables, and whole grains, is associated with a significant reduction in overall mortality, mortality from cardiovascular diseases, incidence of mortality from cancer, and incidence of Parkinson’s disease and Alzheimer’s disease.²² Although promising, research on isolated components of the diet has been inconclusive,^22-26 suggesting that its benefits may be derived less from food and more from a decrease in psychological distress and a greater feeling of belonging to the community.²⁷ Indeed, it may be necessary to refer more to a “Mediterranean lifestyle” of which diet is but one component.²⁸ In a society in which obesity, hypertension, dyslipidemia, and diabetes are rampant, not to mention anxiety, sickness, depression, and unhappiness, scientists are discovering that the act of eating alone has a detrimental effect on the quality of life and the dietary status.²⁹ By contrast, shared family meals among young adults are associated with healthier diets³⁰and better eating habits.³¹

Regardless of the science, to eat together is to belong to a community, feeding both body and soul. This is what is experienced when sharing a meal in southern Europe, the home of Mediterranean culture, where “at the table” is not only a way of eating but also a way of living.

References

1. Lévi-Strauss C. Tristes Trópicos. Lisboa: Edições 70 2004.
2. Elias N. O processo civilizacional. Lisboa: Publicações Dom Quixote 2006.
3. da Silva, A. Ir à Índia sem abandonar Portugal. Lisboa: Assírio & Alvim 1994.
4. Naïr S, Morin E. Uma Política de Civilização. Lisboa: Instituto Piaget 1997.
5. Pollan M. Omnivore’s Dilemma. London: The Penguin Press 2006.
6. Filipski E, Innominato PF, Wu M, et al. Effects of light and food schedules on liver and tumor molecular clocks in mice. J Natl Cancer Inst 2005; 97:507-517.
7. Buijs RM, , Kreier F, Yi C, et al. Organization of circadian functions: interaction with the body. Prog Brain Res 2006;153:341-60.
8. Scheer FAJL, Hilton MF, et al (2009) Adverse metabolic and cardiovascular consequences of circadian misalignment. PNAS 106 : 4453–4458.
9. Huang W, Ramsey KM, Marcheva B, Bass J(2011) Circadian rhythms, sleep, and metabolism. J Clin Invest 121: 2133-2141.
10. Li XM, Delaunay F, Dulong S, et al. Cancer inhibition through circadian reprogramming of tumor transcriptome with meal timing. Cancer Res 2010; 70:3351-3360.
11. Zandian M, Ioakimidis I, Bergström J, et al. Children eat their school lunch too quickly: an exploratory study of the effect on food intake. BMC Public Health 2012; 12:351. doi: 10.1186/1471-2458-12-351.
12. Keith SW, Redden DT, Katzmarzyc PT, et al. Putative contributers to the secular increase of obesity: exploring the roads less travelled. Int J Obes 2000; 30:1585-1594.
13. McEwen BS, Lasley EN. The End of Stress As We Know It. Joseph Henry Press 2004.
14. Kuo LE, Czarnecka M, Kitlinska JB, et al. Chronic stress, combined with a high-fat/high-sugar diet, shifts sympathetic signaling toward neuropeptide Y and leads to obesity and the metabolic syndrome. Ann N Y Acad Sci 2008;1148:232-237.
15. Toyoshima H, Masuoka N, Hashimoto S, et al. Effect of the interaction between mental stress and eating pattern on body mass index gain in healthy Japanese male workers. J Epidemiol 2009; 19:88-93.
16. Pollan M. In Defense of Food: An Eater’s Manifesto. New York: Penguin Press 2008.
17. Kushi LH, Lenart EB, Willett WC. Health implications of Mediterranean diets in light of contemporary knowledge. 1. Plant foods and dairy products. Am J Clin Nutr. 1995;61(6 Suppl):1407S-1415S.
18. Kushi LH, Lenart EB, Willett WC. Health implications of Mediterranean diets in light of contemporary knowledge. 2. Meat, wine, fats, and oils. Am J Clin Nutr. 1995; 61 (6 Suppl):1416S-1427S.
19. Sofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherence to Mediterranean diet and health status: meta-analysis. BMJ 2008; 337:a1344.
20. Estruch R, Ros E, Salas-Salvadó J, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N Engl J Med. 2013 Feb 25. [Epub ahead of print]
21. Stockley C, Teissedre PL, Boban M, et al. Bioavailability of wine-derived phenolic compounds in humans: a review. Food Funct 2012; 3:995-1007.
22. Zamora-Ros R, Urpi-Sarda M, Lamuela-Raventós RM, et al. High urinary levels of resveratrol metabolites are associated with a reduction in the prevalence of cardiovascular risk factors in high-risk patients. Pharmacol Res. 2012; 65: 615-620. doi: 10.1016/j.phrs.2012.03.009.
23. Hadziabdić MO, Bozikov V, Pavić E, Romić Z. The antioxidative protecting role of the Mediterranean diet. Coll Antropol 2012;36:1427-434.
24. Kesse-Guyot E, Andreeva VA, Lassale C, et al. Mediterranean diet and cognitive function: a French study. Am J Clin Nutr. 2013; 97:369-376. doi: 10.3945/ajcn.112.047993.
25. Féart C, Samieri C, Allès B, Barberger-Gateau P. Potential benefits of adherence to the Mediterranean diet on cognitive health. Proc Nutr Soc. 2013; 72:140-152. doi: 10.1017/S0029665112002959.
26. Sánchez-Villegas A, Delgado-Rodríguez M, Alonso A, et al. Association of the Mediterranean dietary pattern with the incidence of depression: the Seguimiento Universidad de Navarra/University of Navarra follow-up (SUN) cohort. Arch Gen Psychiatry 2009; 66:1090-1098. doi: 10.1001/archgenpsychiatry.2009.129
27. Hodge A, Almeida OP, English DR, et al. Patterns of dietary intake and psychological distress in older Australians: benefits not just from a Mediterranean diet. Int Psychogeriatr 2013; 25:456-466. doi: 10.1017/S1041610212001986.
28. del Balzo V, Diolordi L, Pinto A, et al. Mediterranean diet pyramids: towards the Italian model. Ann Ig. 2012; 24:443-447.
29. Kimura Y, Wada T, Okumiya K, et al. Eating alone among community-dwelling Japanese elderly: association with depression and food diversity.J Nutr Health Aging 2012; 16:728-731. doi: 10.1007/s12603-012-0067-3.
30. Larson N, Fulkerson J, Story M, Neumark-Sztainer D. Shared meals among young adults are associated with better diet quality and predicted by family meal patterns during adolescence. Public Health Nutr 2012; 3:1-11.
31. Laurier E, Wiggins S. Finishing the family meal. The interactional organisation of satiety. Appetite 2011; 56:53-64.