Association Between Health Literacy and BMI: A Cross-Sectional Study of Suburban Adult Population in Bangladesh

Main Article Content

Md. Karimul Islam
Nishad Nasrin
Abu Jaber
Md. Tanvir Hossain

Abstract

Bangladesh is experiencing heightened incidences of obesity among its urban population. This study investigated the relationship between health literacy and body mass index (BMI) among the suburban adult population in the southwestern region of Bangladesh. Data were collected from 196 random participants. Inferential statistics and multinomial logistic regression were used to analyze the data. The BMI was calculated using the World Health Organization standard, and a health literacy index was constructed using the principal component analysis. Results obtained from the relative risk ratio suggested that a higher level of health literacy directly correlates with a reduction of the obesity, overweight, and underweight categories. The health literacy indicators, including healthy behavior (0.38, p<0.01), nutrition knowledge (0.47, p<0.10), and preventive care knowledge (0.47, p<0.05), significantly influenced BMI. Furthermore, years of schooling have a substantial negative effect on the underweight category (0.71, p<0.01). The government should launch health literacy campaigns at all levels of education and promote the campaigns through social and mass media. A longitudinal study on nationally representative samples should be carried out to assess the impact of health literacy campaigns on the overall health and well-being of the Bangladeshi population.

Downloads

Download data is not yet available.

Article Details

Section
Articles
Author Biography

Nishad Nasrin, Economics Discipline, Social Science School, Khulna University, Bangladesh

Corresponding author

References

• Abdulraheem, I. S., Olapipo, A. R., & Amodu, M. O. (2012). Primary health care services in Nigeria: Critical issues and strategies for enhancing the use by the rural communities. Journal of Public Health and Epidemiology, 4(1), 5-13. https://doi.org/10.5897/JPHE11.133

• Ahmed, F., Prendiville, N., & Narayan, A. (2016). Micronutrient deficiencies among children and women in Bangladesh: Progress and challenges. Journal of Nutritional Science, 5, Article E46. https://doi.org/10.1017/jns.2016.39

• Ahmed, S., Creanga, A. A., Gillespie, D. G., & Tsui, A. O. (2010). Economic status, education and empowerment: Implications for maternal health service utilization in developing countries. PloS ONE, 5(6), Article e11190. https://doi.org/10.1371/journal.pone.0011190

• Al Junaibi, A., Abdulle, A., Sabri, S., Hag-Ali, M., & Nagelkerke, N. (2013). The prevalence and potential determinants of obesity among school children and adolescents in Abu Dhabi, United Arab Emirates. International Journal of Obesity, 37, 68-74. https://doi.org/10.1038/ijo.2012.131

• Alam, D. S., Talukder, S. H., Chowdhury, M. A. H., Siddiquee, A. T., Ahmed, S., Pervin, S., Khan, S., Hasan, K., Koehjmoos, T. L. P., & Niessen, L. W. (2016). Overweight and abdominal obesity as determinants of undiagnosed diabetes and pre-diabetes in Bangladesh. BMC Obesity, 3, Article 19. https://doi.org/10.1186/s40608-016-0099-z

• Alemu, E., Atnafu, A., Yitayal, M., & Yimam, K. (2014). Prevalence of overweight and/or obesity and associated factors among high school adolescents in Arada Sub city, Addis Ababa, Ethiopia. Journal of Nutrition & Food Sciences, 4(2), Article 1000261. http://dx.doi.org/10.4172/2155-9600.1000261

• Altin, S. V., Finke, I., Kautz-Freimuth, S., & Stock, S. (2014). The evolution of health literacy assessment tools: A systematic review. BMC Public Health, 14, Article 1207. https://doi.org/10.1186/1471-2458-14-1207

• Arabin, B., Timmesfeld, N., Noever, K., Behnam, S., Ellermann, C., & Jenny, M. A. (2019). How to improve health literacy to reduce short- and long-term consequences of maternal obesity? The Journal of Maternal-Fetal & Neonatal Medicine, 32(17), 2935-2942. https://doi.org/10.1080/14767058.2018.1450383

• Bangladesh Bureau of Statistics. (2015a). Changing pattern of urbanization in Bangladesh: An analysis of census data (Population Monograph: Vol. 12).

• Bangladesh Bureau of Statistics. (2015b). Education and literacy in Bangladesh: An analysis from social inclusion perspective (Population Monograph: Vol. 2).

• Bangladesh Bureau of Statistics. (2015c). Population and Housing Census 2011- Zila Report: Khulna.

• Bangladesh Bureau of Statistics. (2015d). Population density and vulnerability: A challenge for sustainable development of Bangladesh (Population Monograph: Vol. 7).

• Bashar, M. A., Haque, A. R., & Rahman, R. (2020). Prevalence of anaemia among pregnant women in a rural area of Bangladesh: Impact of socio-economic factors, food intake and micronutrient supplementation. American Journal of Pure and Applied Biosciences, 2(1), 1-7. https://doi.org/10.34104/ajpab.0200107

• Biswas, T., Garnett, P. S., Pervin S., & Rawal, L. B. (2017). The prevalence of underweight, overweight and obesity in Bangladeshi adults: Data from a national survey. PloS ONE, 12(5), Article e0177395. https://doi.org/10.1371/journal.pone.0177395

• Biswas, T., Islam, A., Islam, M. S., Pervin, S., & Rawal, L. B. (2017). Overweight and obesity among children and adolescents in Bangladesh: A systematic review and meta-analysis. Public Health, 142, 94-101. https://doi.org/10.1016/j.puhe.2016.10.010

• Bleich, S. N., Bennett, W. L., Gudzune, K. A., & Cooper, L. A. (2012). Impact of physician BMI on obesity care and beliefs. Obesity, 20(5), 999-1005. https://doi.org/10.1038/oby.2011.402

• Cha, E., Kim, K. H., Lerner, H. M., Dawkins, C. R., Bello, M. K., Umpierrez, G., & Dunbar, S. B. (2014). Health literacy, self-efficacy, food label use, and diet in young adults. American Journal of Health Behavior, 38(3), 331-339. https://doi.org/10.5993/AJHB.38.3.2

• Chari, R., Warsh, J., Ketterer, T., Hossain, J., & Sharif, I. (2014). Association between health literacy and child and adolescent obesity. Patient Education and Counseling, 94(1), 61-66. https://doi.org/10.1016/j.pec.2013.09.006

• Cheng, Y. L., Shu, J. H., Hsu, H. C., Liang, Y., Chou, R. H., Hsu, P. F., Wang, Y. J., Ding, Y. Z., Liou, T. L., Wang, Y. W., Huang, S. S., Lin, C. C., Lu, T. M., Leu, H. B., Lin, S. J., & Chan, W. L. (2018). High health literacy is associated with less obesity and lower Framingham risk score: Sub-study of the VGH-HEALTHCARE trial. PloS ONE, 13(3), Article e0194813. https://doi.org/10.1371/journal.pone.0194813

• Cho, Y. I., Lee, S. Y. D., Arozullah, A. M., & Crittenden, K. S. (2008). Effects of health literacy on health status and health service utilization amongst the elderly. Social Science & Medicine, 66(8), 1809-1816. https://doi.org/10.1016/j.socscimed.2008.01.003

• Di Tecco, C., Fontana, L., Adamo, G., Petyx, M., & Iavicoli, S. (2020). Gender differences and occupational factors for the risk of obesity in the Italian working population. BMC Public Health, 20, Article 706. https://doi.org/10.1186/s12889-020-08817-z

• Eltayeb, R., Salmiah, M. S., & Suriani, I. (2016). Association of health literacy with obesity and overweight among Arabic secondary school students in Kuala Lumpur and Putrajaya, Malaysia. International Journal of Public Health and Clinical Sciences, 3(5), 110-121. http://publichealthmy.org/ejournal/ojs2/index.php/ijphcs/article/view/348

• Enomoto, A., Saito, A., Takahashi, O., Kimura, T., Tajima, R., Rahman, M., & Iida, K. (2020). Associations between health literacy and underweight and overweight among Japanese adults aged 20 to 39 years: A cross-sectional study. Health Education & Behavior, 47(4), 631-639. https://doi.org/10.1177/1090198120919675

• Feinstein, J. S. (1993). The relationship between socioeconomic status and health: A review of the literature. The Milbank Quarterly, 71(2), 279-322. https://doi.org/10.2307/3350401

• Frederick, C. B., Snellman, K., & Putnam, R. D. (2014). Increasing socioeconomic disparities in adolescent obesity. Proceedings of the National Academy of Sciences, 111(4), 1338-1342. https://doi.org/10.1073/pnas.1321355110

• Freedman, D. A., Bess, K. D., Tucker, H. A., Boyd, D. L., Tuchman, A. M., & Wallston, K. A. (2009). Public health literacy defined. American Journal of Preventive Medicine, 36(5), 446-451. https://doi.org/10.1016/j.amepre.2009.02.001

• Garawi, F., Devries, K., Thorogood, N., & Uauy, R. (2014). Global differences between women and men in the prevalence of obesity: Is there an association with gender inequality? European Journal of Clinical Nutrition, 68, 1101-1106. https://doi.org/10.1038/ejcn.2014.86

• GBD 2015 Obesity Collaborators. (2017). Health effects of overweight and obesity in 195 countries over 25 years. New England Journal of Medicine, 377, 13-27. https://doi.org/10.1056/NEJMoa1614362

• Guo, S., Yu, X., Davis, E., Armstrong, R., Riggs, E., & Naccarella, L. (2020). Adolescent health literacy in Beijing and Melbourne: A cross-cultural comparison. International Journal of Environmental Research and Public Health, 17(4), Article 1242. https://doi.org/10.3390/ijerph17041242

• Haney, M. O. (2020). Health literacy and predictors of body weight in Turkish children. Journal of Pediatric Nursing, 55, e257-e262. https://doi.org/10.1016/j.pedn.2020.05.012

• Hossain, M. B., Khan, J. R., Adhikary, A. C., Anwar, A. H. M. M., Raheem, E., Siddiqee, M. H., & Hossain, M. S. (2021). Association between childhood overweight/obesity and urbanization in developing countries: Evidence from Bangladesh. Journal of Public Health, 2021, 1-10. https://doi.org/10.1007/s10389-021-01560-8

• Hruby, A., & Hu, F. B. (2015). The epidemiology of obesity: A big picture. PharmacoEconomics, 33, 673-689. https://doi.org/10.1007/s40273-014-0243-x

• Hughes, A., & Kumari, M. (2017). Unemployment, underweight, and obesity: Findings from Understanding Society (UKHLS). Preventive Medicine, 97, 19-25. https://doi.org/10.1016/j.ypmed.2016.12.045

• Ishaque, A., Ahmad, F., Zehra, N., & Amin, H. (2012). Frequency of and factors leading to obesity and overweight in school children. Journal of Ayub Medical College Abbottabad, 24(2), 34-38. https://pubmed.ncbi.nlm.nih.gov/24397047/

• Islam, M. S., & Ullah, M. W. (2009). People’s participation in health services: A study of Bangladesh’s rural health complex. Bangladesh Development Research Center (BDRC), Working Paper Series 7. http://bangladeshstudies.org/files/WPS_no7.pdf

• James, D. C. S., Harville, C., Efunbumi, O., & Martin, M. Y. (2015). Health literacy issues surrounding weight management among African American women: A mixed methods study. Journal of Human Nutrition and Dietetics, 28(s2), 41-49. https://doi.org/10.1111/jhn.12239

• Kanter, R., & Caballero, B. (2012). Global gender disparities in obesity: A review. Advances in Nutrition, 3(4), 491-498. https://doi.org/10.3945/an.112.002063

• Khan, J. R., & Awan, N. (2017). A comprehensive analysis on child mortality and its determinants in Bangladesh using frailty models. Archives of Public Health, 75, Article 58. https://doi.org/10.1186/s13690-017-0224-6

• Khullar, D., & Chokshi, D. A. (2018). Health, income, & poverty: Where we are & what could help. Health Affairs Health Policy Brief. https://doi.org/10.1377/hpb20180817.901935

• Kumar, R. H., Venkaiah, K., Arlappa, N., Kumar, S., Brahmam, G. N. V., & Vijayaraghavan, K. (2005). Diet and nutritional situation of the population in the severely drought affected areas of Gujarat. Journal of Human Ecology, 18(4), 319-326. https://doi.org/10.1080/09709274.2005.11905849

• Lam, L. T., & Yang, L. (2014). Is low health literacy associated with overweight and obesity in adolescents: an epidemiology study in a 12–16 years old population, Nanning, China, 2012. Archives of Public Health, 72, Article 11. https://doi.org/10.1186/2049-3258-72-11

• Lanpher, M. G., Askew, S., & Bennett, G. G. (2016). Health literacy and weight change in a digital health intervention for women: A randomized controlled trial in primary care practice. Journal of Health Communication, 21(sup1), 34-42. https://doi.org/10.1080/10810730.2015.1131773

• Lassetter, J. H., Clark, L., Morgan, S. E., Brown, L. B., VanServellen, G., Duncan, K., & Hopkins, E. S. (2015). Health literacy and obesity among Native Hawaiian and Pacific Islanders in the United States. Public Health Nursing, 32(1), 15-23. https://doi.org/10.1111/phn.12155

• Liu, Y. B., Liu, L., Li, Y. F., & Chen, Y. L. (2015). Relationship between health literacy, health-related behaviors and health status: A survey of elderly Chinese. International Journal of Environmental Research and Public Health, 12(8), 9714-9725. https://doi.org/10.3390/ijerph120809714

• Michou, M., Panagiotakos, D. B., & Costarelli, V. (2018). Low health literacy and excess body weight: A systematic review. Central European Journal of Public Health, 26(3), 234-241. https://doi.org/10.21101/cejph.a5172

• Mirowsky, J., & Ross, C. E. (2003). Education, social status, and health (1st ed.). Routledge.

• Moghaddam, R., Mokhtari Lakeh, N., Rahebi, S. M., & Kazemnezhad Leili, E. (2019). Health literacy and its relationship with body mass index. Journal of Holistic Nursing and Midwifery, 29(3), 8-14. http://dx.doi.org/10.32598/JHNM.29.3.130

• Muhammad, F., Chowdhury, M., Arifuzzaman, M., & Chowdhury, A. A. (2016). Public health problems in Bangladesh: Issues and challenges. South East Asia Journal of Public Health, 6(2), 11-16. http://dx.doi.org/10.3329/seajph.v6i2.31830

• Mohiuddin, A. K., & Nasirullah, M. (2019). UTI prevalence among population with chronic conditions. Journal of Medical Research and Case Reports, 1(2), 1-13. https://escientificpublishers.com/assets/data1/images/JMRCR-01-0011.pdf

• Musaiger, A. O. (2011). Overweight and obesity in Eastern Mediterranean region: Prevalence and possible causes. Journal of Obesity, 2011, Article 407237. https://doi.org/10.1155/2011/407237

• Nakamura, D., Ogawa, M., Nakamura, T., & Izawa, K. P. (2018). Impact of parents’ comprehensive health literacy on BMI in children: A multicenter cross‐sectional study in Japan. Journal of School Health, 88(12), 910-916. https://doi.org/10.1111/josh.12700

• Nakamura, T., Nakamura, Y., Saitoh, S., Okamura, T., Yanagita, M., Yoshita, K., Kita, Y., Murakami, Y., Yokomichi, H., Nishi, N., Okuda, N., Kadota, A., Ohkubo, T., Ueshima, H., Okayama, A., & Miura, K. (2018). Relationship between socioeconomic status and the prevalence of underweight, overweight or obesity in a general Japanese population: NIPPON DATA 2010. Journal of Epidemiology, 28(Supplement III), S10-S16. https://doi.org/10.2188/jea.JE20170249

• Nutbeam, D. (2000). Health literacy as a public goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International, 15(3), 259-267. https://doi.org/10.1093/heapro/15.3.259

• Nuttall, F. Q. (2015). Body mass index: Obesity, BMI, and health: A critical review. Nutrition Today, 50(3), 117-128. https://doi.org/10.1097/NT.0000000000000092

• O′ Neill, B., Gonçalves, D., Ricci-Cabello, I., Ziebland, S., & Valderas, J. (2014). An overview of self-administered health literacy instruments. PloS ONE, 9(12), Article e109110. https://doi.org/10.1371/journal.pone.0109110

• Osborne, R. H., Elsworth, G. R., & Whitfield, K. (2007). The Health Education Impact Questionnaire (heiQ): An outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions. Patient Education and Counselling, 66(2), 192-201. https://doi.org/10.1016/j.pec.2006.12.002

• Rachmi, C. N., Li, M., & Baur, L. A. (2017). Overweight and obesity in Indonesia: Prevalence and risk factors—a literature review. Public Health, 147, 20-29. https://doi.org/10.1016/j.puhe.2017.02.002

• Rahman, S., Lee, P., Raqib, R., Roy, A. K., Khan, M. R., & Ahmed, F. (2019). Effect of Micronutrient Powder (MNP) with a low-dose of iron on hemoglobin and iron biomarkers, and its effect on morbidities in rural Bangladeshi children drinking groundwater with a high-level of iron: A randomized controlled trial. Nutrients, 11(11), Article e2756. https://doi.org/10.3390/nu11112756

• Ross, C. E., & Wu, C. (1995). The links between education and health. American Sociological Review, 60(5), 719-745. https://doi.org/10.2307/2096319

• Schmeer, K. K. (2010). Household income during childhood and young adult weight status: Evidence from a nutrition transition setting. Journal of Health and Social Behavior, 51(1), 79-91. https://doi.org/10.1177/0022146509361178

• Scott, T. L., Gazmararian, J. A., Williams, M. V., & Baker, D. W. (2002). Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Medical Care, 40(5), 395-404. https://doi.org/10.1097/00005650-200205000-00005

• Sentell, T., Baker, K. K., Onaka, A., & Braun, K. (2011). Low health literacy and poor health status in Asian Americans and Pacific Islanders in Hawai’i. Journal of Health Communication, 16(sup3), 279-294. https://doi.org/10.1080/10810730.2011.604390

• Shih, S. F., Liu, C. H., Liao, L. L., & Osborne, R. H. (2016). Health literacy and the determinants of obesity: A population-based survey of sixth grade school children in Taiwan. BMC Public Health, 16, Article 280. https://doi.org/10.1186/s12889-016-2879-2

• Shimokata, H., & Kuzuya, F. (1993). Aging, basal metabolic rate, and nutrition. Japanese Journal of Geriatrics, 30(7), 572–576. https://doi.org/10.3143/geriatrics.30.572

• Smith, K. R., Brown, B. B., Yamada, I., Kowaleski-Jones, L., Zick, C. D., & Fan, J. X. (2008). Walkability and body mass index: Density, design, and new diversity measures. American Journal of Preventive Medicine, 35(3), 237-244. https://doi.org/10.1016/j.amepre.2008.05.028

• Sørensen, K., Van den Broucke., S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., & Brand, H., (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12, Article 80. https://doi.org/10.1186/1471-2458-12-80

• Steyn, N. P., Nel, J. H., Parker, W. A., Ayah, R., & Mbithe, D. (2011). Dietary, social, and environmental determinants of obesity in Kenyan women. Scandinavian Journal of Public Health, 39(1), 88-97. https://doi.org/10.1177/1403494810384426

• Stöver, B. (2012). The influence of age on consumption. Discussion Paper No. 49080. Gesellschaft für Wirtschaftliche Strukturforschung mbH. http://ecomod.net/system/files/Discussion%20Paper_Britta%20Stoever.pdf

• Svendsen, M. T., Bak, C. K., Sørensen, K., Pelikan, J., Riddersholm, S. J., Skals, R. K., Mortensen, R. N., Maindal, H. T., Bøggild, H., Nielsen, G., & Torp-Pedersen, C. (2020). Associations of health literacy with socioeconomic position, health risk behavior, and health status: A large national population-based survey among Danish adults. BMC Public Health, 20, Article 565. https://doi.org/10.1186/s12889-020-08498-8

• Tanwi, T. S., Chakrabarty, S., Hasanuzzaman, S., Saltmarsh, S., & Winn, S. (2019). Socioeconomic correlates of overweight and obesity among ever-married urban women in Bangladesh. BMC Public Health, 19, Article 842. https://doi.org/10.1186/s12889-019-7221-3

• Tareque, M. I., Saito, Y., & Kawahara, K. (2015). Healthy life expectancy and the correlates of self-rated health in Bangladesh in 1996 and 2002. BMC Public Health, 15, Article 312. https://doi.org/10.1186/s12889-015-1640-6

• Taylor, C. B., Fortmann, S. P., Flora, J., Kayman, S., Barrett, D. C., Jatulis, D., & Farquhar, J. W. (1991). Effect of long-term community health education on body mass index: The Stanford Five-City Project. American Journal of Epidemiology, 134(3), 235-249. https://doi.org/10.1093/oxfordjournals.aje.a116077

• Tian, C. Y., Xu, R. H., Mo, P. K. H., Dong, D., & Wong, E. L. Y. (2020). Generic health literacy measurements for adults: A scoping review. International Journal of Environmental Research and Public Health, 17(21), Article 7768. https://doi.org/10.3390/ijerph17217768

• Woolf, S. H., Aron, L., Dubay, L., Simon, S. M., Zimmerman, E., & Luk, K. X. (2015). How are income and wealth linked to health and longevity? Urban Institute and Virginia Commonwealth University. http://webarchive.urban.org/UploadedPDF/2000178-How-are-Income-and-Wealth-Linked-to-Health-and-Longevity.pdf

• World Bank. (2021). Country Profile: Bangladesh [Data set]. World Bank Group. https://data.worldbank.org/country/bangladesh