Low Health Literacy Hinders Accurate Perceptions of Body Weight among Mexican Women
Authors: Aguayo Liliana , Sandberg Erin , Schwingel Andiara , Wiley Angela 
Published: June 2021

Obesity is increasingly prevalent among Mexicans living in Mexico and the U.S. Mexican adults have lower health literacy than non‐Hispanic adults living in the US. Low health literacy is associated with poor understanding of obesity, and comorbidity risks. Lack of awareness of the risks of obesity often compromises timely identification and hinders the prevention and treatment of obesity. While associations of poor health literacy and poor use of preventive services, and adherence to treatment regimens are well established, the mechanisms remain poorly understood, particularly among Mexican families. The purpose of this pilot study is to explore potential associations between health literacy and perceptions of body weight for Mexican women and their 5 and 6 year old children. We hypothesized that low health literacy would preclude Mexican mothers from accurately identifying their own weight status and obesity risks, and thus, will impact their children's proper weight identification and obesity risks. A revised version of the Stunkard's Figure Rating Scale (FRS) was administered to 24 Mexican mothers living in urban settings in Mexico (n= 12), and the US (n= 12). Mothers were asked to identify their “real” and their “ideal” figures on a figure scale, as well as their children's “real” and “ideal” figures. Health literacy was assessed using the Spanish version of the short form of the Test of Functional Health Literacy in Adults (S‐TOFHLA) and the Spanish version of the Newest Vital Sign (NVS) Instrument. Body composition was collected via bioelectrical impedance with non‐pregnant participants (n = 22) and their children (n = 24). Spearman's rank‐order correlations (rs) were used to determine the relationships between health literacy and accuracy of perceptions of body weight. There was a statistically significant negative correlation between mothers' S‐TOFHLA scores, and mothers' accuracy in their perceptions of their body weight (rs = −0.48, p < 0.05). However, mothers' perception of children's “real” weight and children's weight was not significantly associated to mothers' health literacy scores. We found a strong statistically significant positive correlation between mothers' perceived “real” and “ideal” body weight (rs= 0.683, p < 0.001), and perceptions of children's “real” and “ideal” body weight (rs= 0.553, p < 0.01). These relationships were independent of health literacy scores for both health literacy tests. While mothers' BMI was significantly correlated with S‐TOFHLA scores (rs= −0.43, p < 0.05), there was no statistically significant association between BMI and NVS scores. Assessments of health literacy of Mexican women have the potential to inform health professionals about barriers to awareness, proper identification of obesity risks, and barriers to achieving health outcomes. Considering many of the Mexican women did not identify a healthy weight as the “ideal” for themselves or for their children, the relationships found between perceptions of “real” and “ideal” body weight introduce an important challenge to obesity prevention and treatment efforts. Further research is recommended to understand the impact of health literacy on acceptability of Mexican mothers' monitoring their own weight and their childrens' growth.Support or Funding InformationThis material is based upon work that is supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, under award number 2011‐67001‐30101.