Recent studies suggest that health literacy (HL) may play an important role in management of individuals living with severe obesity (BMI ≥ 40 kg/m2), but to date, there has been no attempt to synthesize characteristics and outcomes of these studies. To explore the prevalence of low HL in people with severe obesity, and how HL may impact on health outcomes and management of severe obesity, six databases and two independent journals were searched. Seventeen studies were included in this review, mostly undertaken in high income countries, among females and candidates of bariatric surgery. Low HL ranged from 3.7% to 57.9% in cohorts studied, possibly explained by the heterogeneity of HL tools (i.e., seven different validated tools). Eight studies found higher HL to lead to better treatment outcomes (e.g., weight loss, attending appointments). Thematic synthesis of qualitative studies identified a lack of access to health information and support from healthcare providers (domains of HL) as barriers in improving health in patients with severe obesity. There is notable gap in interventional studies on improving HL in people with severe obesity. Overall, HL seems to be an important predictor of health outcomes in management of severe obesity. Further research is needed to assess the impact of HL on a broader range of health outcomes in nonsurgical patients with severe obesity.
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