Lake Chapala is the main freshwater reservoir in Mexico and faces notable environmental pressure associated with urban, industrial, and agricultural activities, with documented evidence of heavy metal contamination. Thus, the artisanal fishers from Lake Chapala occupy a strategic position for understanding the socio-environmental dynamics of this lacustrine system. The objective of this study was to analyze their perceptions of pollution in Lake Chapala and the health risks associated with heavy metal contamination, with particular emphasis on the consumption of charal (Chirostoma spp.). Based on the results, 70% of fishers agreed that Lake Chapala is polluted, and 50% identified solid waste as the main source of contamination. Regarding water quality, 41% considered that it had not changed in recent years, while 37% perceived that it had deteriorated. With respect to heavy metals, 50% reported being aware of their presence in the lake; however, slightly more than 50% expressed concern about the possibility that charal could be contaminated. Fishers acknowledged the environmental pressure faced by Lake Chapala but prioritized risks based on visibility and their everyday experiences. Incorporating the perceptions of key stakeholders is essential for addressing socio-environmental problems, strengthening environmental communication and public health strategies, and effectively managing this lacustrine system.