An estimated 14.5 million American households had difficulty providing enough food for their families last year, according to a recent government report. In 7 million of those homes, at least one member of the family had to skip meals or eat less because money was tight. These numbers are more or less unchanged since 2008.

A U.S. Department of Agriculture (USDA) Economic Research Service report measures how many households have to limit their food options or even skip meals because they cannot afford enough or healthier food. According to the report, between 2010 and 2012, an average of 20% of Mississippi households had low or very low food security. In that period, an average of one in 12 Arkansas households had at least one family member skip a meal or eat less because of a lack of money. These are the states where the most people go hungry.

Click here to see the 10 states 

The states with the lowest food security, not surprisingly, are among the poorest in the country. In all 10 states, the median household income was less than the national median of $50,502. In Mississippi and Arkansas, the two worst states for food security, median income was less than $40,000. Of the 10 states with the lowest food security, eight had the highest poverty rates in the country.

Ross Fraser, spokesperson for hunger-relief charity Feeding America, explained that having low food security does not necessarily mean families are starving. While people may feel full after eating, nutritious food is expensive. “Often, people have to make unfortunate choices about what they put in their stomachs.” Fraser added.

Indeed, according to a 2012 Gallup-Healthways survey, people in nine of the 10 states were less likely to eat healthily on a daily basis than the nation as a whole. Missouri and Tennessee were third and second worst in the country by this measure.

It may surprise some that, in fact, the majority of the 10 states with food access problems have higher-than-average obesity rates. Mississippi and Arkansas had the second and third highest obesity rates in the country in 2012. “The lack of healthy food among families in these states,” explained Fraser, “is one of the reasons you have very poor people who are obese. It is because they’re not able to afford nutritious and high protein food.”

Based on a three-year average between 2010 and 2012, the USDA‘s report, Household Food Security in the United States in 2012, identifies the states with the highest proportion of residents who had low or very low food security. The report measures how many households have low food security — defined as being able to eat three square meals a day, but forced to reduce the quality of the food they eat — and very low food security — defined as having food intake reduced and eating patterns disrupted because of a lack of affordability. The 2000-2002 and 2007-2009 averages also were considered. 24/7 Wall St. also reviewed poverty, income, education and food stamp recipiency data from the U.S. Census Bureau’s 2011 American Community Survey, as well as the obesity and access to food data for 2012 from the Gallup-Healthways 2012 Well-Being Index.

These are the states where the most people go hungry.

10. Ohio
> Low food security homes: 16.1%
> Very low food security homes: 7.1% (3rd highest)
> Median household income: $45,749 (16th lowest)
> Pct. obesity: 29.5% (8th highest)

More than 16% of families in Ohio experienced low food security, meaning they had difficulty accessing food and had poor diet quality. This problem was even worse for some families. Ohio also had the third highest percentage of households in the nation, at 7.1%, that had experienced very low food security at some point. In these homes, at least one person had to reduce food intake or had their eating patterns disrupted by irregular access to food.

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9. Tennessee
> Low food security homes: 16.2%
> Very low food security homes: 6.9% (5th highest)
> Median household income: $41,693 (6th lowest)
> Pct. obesity: 29.6% (7th highest)

More than 16% of Tennessee households faced food insecurity at some point. Like in most states, this number rose considerably from the decade before. In 2002, just 11.3% of households faced food insecurity at some point. Similarly, between 2002 and 2012, the average proportion of households facing very low food security more than doubled, from 3.3% to 6.9%. As of 2011, 17.6% of homes received food stamps or Supplemental Nutrition Assistance Program (SNAP) benefits, more than all but two other states. Also, according to Gallup-Healthways, residents in Tennessee were less likely than Americans in almost any other state to eat healthily.

8. Nevada
> Low food security homes: 16.6%
> Very low food security homes: 6.7% (8th highest)
> Median household income: $48,927 (24th lowest)
> Pct. obesity: 24.9% (15th lowest)

Between 2002 and 2012, the percentage of households in Nevada that faced food insecurity rose from 9.3% to 16.6%. This was the largest such increase in the nation. In those 10 years, the percentage of Nevadans facing very low food security jumped as well, from 3.3% in 2002 to 6.7% in 2012. A lack of access to food was hardly the only major constraint facing Nevada residents, who according to Gallup were less likely to have a doctor or health insurance than residents of nearly all other states as of 2012.

7. Missouri
> Low food security homes: 16.7%
> Very low food security homes: 7.6% (2nd highest)
> Median household income: $45,247 (15th lowest)
> Pct. obesity: 27.2% (21st highest)

According to a 2012 Gallup-Healthways survey, residents of just two other states were less likely than Missourians to eat healthily. The falling food security of many of the state’s residents may play a role in their poor diets. Nearly 8% of households faced very low food security, the second highest percentage in the nation. This was up significantly from 3.3% in 2002, and the largest increase in the nation over the 10-year period.

6. Georgia
> Low food security homes: 16.9%
> Very low food security homes: 6.5% (10th highest)
> Median household income: $46,007 (18th lowest)
> Pct. obesity: 28.6% (14th highest)

Several factors likely contribute to food insecurity in Georgia. Georgia had one of the nation’s highest poverty rates in 2011, at 19.1% of all residents. Similarly, 6.4% of families earned less than $10,000 annually as of 2011, one of the highest proportions in the nation. According to a 2012 Gallup survey, Georgia residents were among the most likely in the nation to have lacked money for food at some point. They also were more likely than most Americans to not have a doctor or health insurance coverage.

5. North Carolina
> Low food security homes: 17.0%
> Very low food security homes: 5.5% (24th highest)
> Median household income: $43,916 (12th lowest)
> Pct. obesity: 28.9% (12th highest)

While there are some prosperous regions of the state, North Carolina still has a substantial poverty problem. In 2011, 17.9% of residents were living below the poverty line, the 13th highest rate in the country. More than one in five people surveyed in 2012 by Gallup-Healthways said they had not had enough money to buy food their family needed in the past 12 months. North Carolina’s food security problems have worsened during the recession. In 2009, 14.8% of families had low or very low food security. In 2012, it was 17% of families.

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4. Alabama
> Low food security homes: 17.9%
> Very low food security homes: 6.8% (7th highest)
> Median household income: $41,415 (5th lowest)
> Pct. obesity: 30.4% (5th highest)

Alabama residents practiced less healthy behavior than most Americans as of 2012. Residents were among the most likely to smoke and the least likely to exercise and eat healthy all day. The lack of healthy eating habits may have been driven by low food security, which results in households reducing “the quality, variety, and desirability of their diets,” according to the USDA. The combination of unhealthy behaviors and limited food access likely has led to Alabama residents being among the most overweight and unfit in the country. According to Gallup, just four states had higher obesity rates than Alabama in 2012.

3. Texas
> Low food security homes: 18.4%
> Very low food security homes: 6.2% (13th highest)
> Median household income: $49,392 (25th highest)
> Pct. obesity: 28.9% (12th highest)

In 2002, close to 15% of Texas households faced low food security each year. By 2012, 18.4% of Texas households experienced low food security. For many residents, low incomes likely prevent access to healthy food. As of 2011, Texas had a poverty rate of 18.5%, among the higher rates in the nation. Additionally, many residents in Texas lack the skills to work a high-paying job. Nearly 19% of the state’s population over age 25 had less than a high school diploma, tying Texas with Mississippi for the highest percentage of any state.

2. Arkansas
> Low food security homes: 19.7%
> Very low food security homes: 8.1% (the highest)
> Median household income: $38,758 (3rd lowest)
> Pct. obesity: 31.4% (3rd highest)

Last year, Arkansas had proportionally more households with very low food security than any other state in the nation, averaging 8.1% of all households. Making it difficult for many residents to afford proper food, Arkansas was one of the nation’s poorest states as of 2011. That year, the median household income was less than $39,000 and one of the lowest in the country. Meanwhile, nearly 20% of the state’s residents lived below the poverty line. With limited, irregular access to nutritious and balanced food, residents were among the most likely to be overweight, based on the results of a 2012 Gallup survey.

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1. Mississippi
> Low food security homes: 20.9%
> Very low food security homes: 6.9% (5th highest)
> Median household income: $36,919 (the lowest)
> Pct. obesity: 32.2% (2nd highest)

One in every five households experienced food insecurity in Mississippi. Residents of the state were among the poorest in the nation in recent years by numerous measures. In 2011, Mississippi had the lowest median household income in the nation, at $36,919, as well as its highest poverty rate, at 22.6% of all residents. Last year, one in four respondents to a Gallup survey stated they had, at some point, lacked the money necessary to feed their family. Even when residents could ensure they did not have to cut back on their meals because of low food security, many likely often had to eat nutritionally poor food. Mississippi residents had among the highest obesity rates in the country.

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