Body Image Distortion, Health Literacy and Obesity‑Related Attitudes Among Highly Educated Adults

Background

Body image distortion (misalignment between self-perceived and objectively measured body size) is a well-recognised phenomenon. However, its relationship with health literacy (HL), obesity awareness (OA), and attitudes toward people with obesity (ATPO) remains underexplored, particularly among highly educated adults. Understanding these associations may reveal important gaps between educational attainment and health-related perception, knowledge, and stigma.

Methods

A cross-sectional study was conducted through an online survey directed to Portuguese adults (≥18 years) with a university education. Body image distortion was defined as a mismatch between self-perceived weight status and BMI (WHO standards) calculated from self-reported height and weight. ATPO were assessed using a composite score of willingness to hire, date, entrust childcare to, and befriend a person with obesity (1–10). HL was measured using the HLS-EU-PT-Q16 (0–50). OA was measured using the Obesity Awareness Scale (0–80). Mann-Whitney U tests were performed (significance set at p < 0.05).

Results

A total of 2589 adults with university education participated (mean age 49.15 years ±12.16, 86.0% female). Respondents were categorised as having distorted (n = 408) or non-distorted (n = 2181) body image. Those with distorted body image showed significantly more negative ATPO (U = 352891.0, Z=-6.653, p < 0.001), lower HL (U = 372276.5, Z=-5.248, p < 0.001), and lower OA (U = 415570.5, Z=-2.122, p = 0.034) compared to those without body image distortion.

Conclusions

Findings suggest that, in highly educated people, body image distortion is linked to lower HL, decreased OA, and more stigmatising ATPO. Targeted interventions addressing body image accuracy, HL, and stigma reduction may be necessary even in highly educated populations, highlighting the need for nuanced public health strategies.

Key messages

• Highly educated adults with body image distortion show lower health literacy, reduced obesity awareness and more negative attitudes toward people with obesity.

• Body image distortion signals gaps in perception, knowledge and stigma, highlighting the need for targeted interventions even among highly educated populations.