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Do People with Type 2 Diabetes 

Think They are Unhealthy? 
A Cross-Sectional Study in Celaya, 
Mexico 

 

Karla C. Paz-Salinas1, Nicolas 

Padilla-Raygoza1,2, Silvia C. 

Delgado-Sandoval1,2, Georgina 

Olvera-Villanueva1,2, Ma Laura 

Ruiz-Paloalto1,3 

 
1Division of Health Sciences and Engineering, Campus 

Celaya Salvatierra, University of Guanajuato, Mexico; 
2Department of Nursing and Obstetrics, Campus Celaya 

Salvatierra, University of Guanajuato, Mexico; 
3Department of Clinical Nursing, Campus Celaya 

Salvatierra, University of Guanajuato, Mexico 

 

Vol. 4, No. 1 (2015)   |   ISSN 2166-7403 (online)  

DOI 10.5195/cajgh.2015.207 |   http://cajgh.pitt.edu 

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PAZ-SALINAS 

 

 

This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 

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Central Asian Journal of Global Health 

Volume 4, No. 1 (2015) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2015.207|http://cajgh.pitt.edu 

 

 

Abstract 

Background: Type 2 diabetes is a chronic disease that presents a significant burden on health care systems in many countries. 

With the rise of obesity, the incidence of Type 2 diabetes has also been steadily increasing. A healthy lifestyle and understanding 

of diabetes management are important factors for delaying the onset of comorbidities associated with Type 2 diabetes. The objective 

of this study was to evaluate the self-perception of health in individuals with Type 2 diabetes as it relates to BMI status, which has 

important implications for the implementation of preventive programs.  

Methods: A cross-sectional lifestyle survey was implemented in the region of Celaya, Guanajuato, Mexico, targeting 100 

participants diagnosed with Type 2 diabetes. Anthropometric measurements and participant characteristics were also obtained. 

Fisher’s exact test was used to determine if the proportions of lifestyles perceptions differed by BMI status.  

Results:  Participants had a mean age of 56.12 ± 10.26, a mean BMI of 29.13 ± 5.48 kg/m2, were mostly married (67.0%), and 

female (70.0%). None of the normal weight participants perceived themselves as unhealthy. 95% of overweight/obese participants 

perceived themselves to be healthy, despite a diagnosis of diabetes and being overweight/obese, while only 5% perceived 

themselves to be unhealthy. However, these differences in the perceptions of health classified by BMI status were not statistically 

significant (p = 0.42). 

Conclusion: Our findings indicate that overweight and obese persons with Type 2 diabetes in Celaya, Mexico may have 

misperceptions about their own health, even though these findings were not statistically significant. These preliminary data 

highlight the importance of implementing prevention and educational programs among those with diabetes, in order to combat 

health misperceptions and raise awareness about the dangers of diabetes and obesity. Furthermore, more research with larger sample 

sizes is needed  in order to fully understand the effects of perception of health on actual health. 

Keywords: Type 2 diabetes, lifestyle, overweight, obesity 

Do People with Type 2 Diabetes 

Think They are Unhealthy? 
A Cross-Sectional Study in Celaya, Mexico 

 

Karla C. Paz-Salinas1, Nicolas Padilla-

Raygoza1,2, Silvia C. Delgado-

Sandoval1,2, Georgina Olvera-

Villanueva1,2, Ma Laura R. Paloalto1,3 

 
1Division of Health Sciences and Engineering, Campus Celaya 

Salvatierra, University of Guanajuato, Mexico; 2Department of 

Nursing and Obstetrics, Campus Celaya Salvatierra, University 

of Guanajuato, Mexico; 3Department of Clinical Nursing, 

Campus Celaya Salvatierra, University of Guanajuato, Mexico 

Research 

Type 2 diabetes is a chronic disease, which 

presents a significant burden on health services in many 

countries,1,2 including low income nations such as 

Afghanistan3 and Bangladesh,4 and middle income 

countries such as Kazakhstan5 and India.6  Type 2 

diabetes is a metabolic disorder characterized by a deficit 

in the production or release of insulin, increasing glucose 

levels in plasma.7,8 This chronic disease and its 

complications are a major cause of morbidity and 

mortality in Mexico,9  with over 400,000 new cases 

reported in Mexico each year.10 

Despite the benefits of maintaining a healthy 

lifestyle to control Type 2 diabetes, many diabetic 

patients do not make healthy lifestyle choices. For 

example, Mexico is now one of the most obese countries 

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CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 

 

 

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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

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in the world with over 1 in 3 adults classified as obese.11 

Lifestyle is the set of behaviors a person adopts in the 

maintenance of health or the occurrence/prevention of 

disease. Healthier lifestyles generally lead to better 

outcomes while unhealthier lifestyles lead to multiple 

diseases or disorders.12,13 Kickbusch et al. defined 

lifestyle as the general way of life based on the 

interaction of life conditions and individual behavior 

patterns, determined by social-cultural factors and an 

individual´s personal characteristics.14 

Physical activity levels and dietary habits are 

related to body mass index (BMI), blood glucose levels, 

HDL cholesterol, and triglycerides, which are in turn 

related to Type 2 diabetes.12,15,16 It is essential to engage 

in regular physical activity and to carefully monitor food 

consumption in order to avoid diabetic complications. 

Lifestyle is a major contributor to disease and health 

outcomes, with a general understanding that if one wants 

to be a healthier person, have a healthier family, and live 

in a healthier community, one must make good lifestyle 

choices. However, since adverse effects of unhealthy 

lifestyles do not manifest immediately, people can fall 

into a vicious cycle of unhealthy behaviors and resist 

healthy lifestyle options due to the fact that they do not 

feel ill, causing a slow but progressive deterioration of 

health which gives rise to expensive chronic 

diseases.13,15,16 

Self-perception of one’s health impacts the 

individual’s choice of lifestyle. Self-perception is the 

looking inward of oneself. Low concordance has been 

reported between nutritional status and self-perception of 

body image;17 for example, previous research in Europe 

demonstrated that 65% of men and 32% women 

underestimated their body weight.18 Lifestyle according 

to self-perception can be modified by improving 

knowledge of what is a desirable healthy lifestyle, and 

reversing misperceptions of self-health.  

This study is of particular importance due to the 

high rates of obesity in Mexico,11 as self-perception of 

health can contribute to obesity, which in turn can 

exacerbate Type 2 diabetes. To our knowledge, no 

studies of this nature have been implemented in Mexico. 

The objective of this study was to determine if there is a 

relationship between the self-perception of lifestyle and 

BMI status in people with Type 2 diabetes residing in 

Celaya, Mexico. 

 

Methods 

The study protocol was reviewed and approved 

by the Research Committee and the Bioethics Committee 

of the Division of Health Sciences and Engineering 

Campus Celaya Salvatierra, University of Guanajuato, 

Mexico. Participants were asked to provide written 

informed consent. Post-consent, participants completed a 

lifestyle questionnaire19 and anthropometric 

measurements were taken. 

This study was a cross-sectional, community-

based study on people with Type 2 diabetes registered in 

Mutual Help Groups (MHG) in the region of Celaya, 

Guanajuato. Participants were selected by simple random 

sampling. Inclusion criteria were the following: prior 

diagnosis of Type 2 diabetes, age of 18 years and older, 

male or female. Exclusion criteria were the following: 

individuals under 18 years of age and those without a 

diagnosis of Type 2 diabetes. 

The lifestyle questionnaire provided a 

dichotomous variable: self-perception lifestyle (SPLS), 

which takes into consideration habits regarding physical 

activity, diet, smoking, alcohol consumption, self-care, 

accident prevention, moral values, environment, stress 

and social support, and sexuality.19 A healthy perception 

is categorized as 41-80 points, and an unhealthy  

perception is categorized as ≤40 points.19 The 

questionnaire measures self-perception of lifestyle but 

cannot measure actual health status. BMI status was 

categorized as a dichotomous variable. Normal BMI 

status was categorized as ≤25 kg/m2, and 

overweight/obese BMI status was categorized as >25 

kg/m2.  

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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 4, No. 1 (2015) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2015.207|http://cajgh.pitt.edu 

 

 

Sample size 

Based on previous studies, sample size was 

calculated by assuming that 70% of those with an 

unhealthy lifestyle perception were overweight/obese 

and 40% of those with a healthy lifestyle were 

overweight/obese. The minimum required sample size 

was 42 for both groups (unhealthy lifestyle perception 

and healthy lifestyle perception), with 95% precision and 

80% power (Epidat, 3.1, 2006, Xunta de Galicia and Pan 

American Health Organization).  

Statistical analysis 

Descriptive statistics were obtained for basic 

participant characteristics. Fisher’s exact test was used to 

analyze the association of lifestyle perception and BMI 

status. All statistical tests were performed using STATA 

13.0® (Stata Corp., College Station, TX, USA). 

 

Results 

The 100 participants had a mean age of 56.12 ± 

10.26 years (70% female, 67% married, mean BMI of 

29.13 ± 5.48 kg/m2). Participant characteristics are 

summarized in Table 1. 

 

Table 1: Qualitative socio-demographic characteristics of 

participants with Type 2 diabetes 

 

81% of participants were classified as 

overweight/obese, and 96% of all participants perceived 

that they had a healthy lifestyle (Table 2). In the 

overweight/obese group, 5% perceived themselves as 

having an unhealthy lifestyle, while 95% perceived 

themselves as having a healthy lifestyle. This 

demonstrates that these people may have a distorted 

lifestyle perception; however, these findings were not 

statistically significant (p = 0.42). 

 

Table 2: Tabulation between perceived lifestyle and 

status of overweight and obesity in participants with 

Type 2 diabetes 

 

Discussion 

The purpose of this study was to evaluate the 

self-perception of health in individuals with Type 2 

diabetes. Only 4% of all participants were found to 

perceive themselves as having an unhealthy lifestyle; 

however, more were expected from the initial power 

analyses, which was a major disadvantage. One 

disadvantage was that the sample size was insufficient to 

detect statistically significant associations. Another 

disadvantage is that the sample was largely of a lower 

level of education, which has been found to be associated 

with obesity and negative health outcomes.20,21 In this 

particular sample, a large percentage of study participants 

was female. This could be due to the fact that females 

tend to utilize health services more than males; however, 

similar results were reported by Lopez-Carmona et al. in 

a diabetic lifestyle instrument validation study.22 

Of the 81% classified as overweight/obese, only 

5% reported having an unhealthy lifestyle perception, 

while 95% reported having a healthy lifestyle. This 

confirmed that there is a distorted perception of lifestyle, 

which can lead to exacerbation of diabetes symptoms.   

In a Ugandan study, Mayega et al., reported that 

only 14% of people with a high intake of fat perceived 

their diet as unhealthy.23 In Uganda, obesity is seen as 

"success" in non diabetic subjects and is desirable among 

women ("big is better"); weight loss is stigmatized as 

being sick and associated HIV / AIDS.23 In Denmark, 

Ulrichsen et al., reported that among 680 people with 

Type 2 diabetes, 36% were obese and 25% had a healthy 

diet.24 In Mexico, Chavez-Courtois, et al. studied a group 

of women with gestational diabetes and reported that 

women perceive physical activity and food as 

fundamental in controlling diabetes, although this does 

not mean that the measures on adequate physical activity 

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and nutrition were implemented as part of treatment for 

diabetes.25 

Patients with Type 2 diabetes typically 

perceived themselves as leading a healthy lifestyle; 

however, 81% of participants were overweight/obese, 

which is not desirable in diabetic patients due to the 

increased risk of diabetic complications or an earlier 

presentation of diabetic complications. 

Patients with Type 2 diabetes receive a large 

amount of information concerning the benefits of a 

healthy lifestyle, and it is possible that this knowledge 

can generate an appropriate perception of a healthier 

lifestyle. This is especially important for those who are 

overweight or obese. We concluded that self-perception 

or self-reported lifestyle is not necessarily accurate and 

cannot be used in future research studies of this 

population without adding objective measures. Future 

research should focus on 1) the association of the self-

perception of lifestyle and co-morbidities in diabetic 

patients, such as eye diseases, circulatory diseases, 

stroke, heart diseases, and 2) designing effective 

educational interventions to increase the awareness of 

unhealthy lifestyles among diabetic patients. 

Acknowledgements  

The authors thank the Faculty Improvement 

Program of the Secretary of Public Education of Mexico 

for its support to the Members of the Healthy Lifestyle 

Academic Group of University of Guanajuato for the 

realization of this project. 

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Central Asian Journal of Global Health 

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Table 1: Qualitative socio-demographic characteristics of participants with Type 2 diabetes 

 Participants with Type 2 Diabetes 

Variables N (%) 

Gender  

     Male 30 (30.0) 

     Female 70 (70.0) 

Marital status  

     Single 13 (13.0) 

     Married 67 (67.0) 

     Divorced 3 (3.0) 

     Separated 4 (4.0) 

     Widowed 9 (9.0) 

     Free union 4 (4.0) 

Education  

     None 28 (28.0) 

     Elementary (Grades 1-6) 27 (27.0) 

     Secondary (Grades 7-8) 19 (19.0) 

     High School (Grades 9-12) 12 (12.0) 

     Bachelor degree 12 (12.0) 

     Graduate degree 2 (2.0) 

 

  

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Table 2: Tabulation between perceived lifestyle and status of overweight and obesity in 

participants with Type 2 diabetes  

Variables Normal Weight 

N (%) 

Overweight/Obese 

N (%) 

Perceived lifestyle   

     Unhealthy 0 (0.0) 4 (4.9) 

     Healthy 19 (100.0) 77 (95.1) 

Note. Normal weight are those with a BMI < 25 kg/m2. Overweight/Obese are those with a BMI ≥ 25 kg/m2. 

 

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