Many Americans consider obesity one of the nation’s most important health issues. Many also battle themselves with the problem every day. According to a recent report, 27.1% of all Americans were obese last year, up from 26.2% the year before.

While many in the United States continue to struggle with their weight, the problem is more pronounced in the southeastern part of the country. Six of the 10 states with the highest obesity rates last year were located in that part of the country. Mississippi was the fattest state in America, with 35.4% of its residents considered obese. Based on figures from the Gallup-Healthways Well-Being Index, 24/7 Wall St. reviewed the 10 states with the highest obesity rates.

Click here to see the Fattest States in America

Poverty is a key predictor that can lead to obesity. All but one of the nation’s 10 most obese states had a higher poverty rate than the U.S. overall, and four of these states were among the top five poverty rates.

In an interview with 24/7 Wall St., Dan Witters, research director for the Gallup-Healthways Well-Being Index, said, “There is no doubt that socioeconomic status is closely related with obesity.” He added, “Demographically, if you want to take a look and try and predict obesity on the ground inside the U.S., you’ll do so more with low income than [other major factors].”

Similarly, lower educational attainment can also lead to higher odds of being obese. The majority of the states with the highest obesity rates were also among the bottom 10 in educational attainment, as measured by the percentage of adults with at least a high school diploma.

Witters also noted the importance of educational attainment. Obesity, he explained, is inversely related to educational achievement. A number of factors explain this relationship, he added, including greater health literacy, better access to health care and cultural norms.

Outside of socioeconomic factors, certain behaviors are more likely to be connected with higher rates of obesity, Witters noted. “We found exercise is the top predictor of obesity, followed closely by smoking and by healthy eating.”

Indeed, seven of the 10 states with the highest obesity rates also had among the 10 highest smoking rates. Similarly, residents in many of these states were among the least likely Americans to eat healthy or to exercise regularly.

High rates of obesity often come with serious health consequences. High cholesterol, hypertension, diabetes and heart disease are all health outcomes that can be tied to obesity, Witters told 24/7 Wall St.

In seven of the 10 states where obesity was most prevalent, residents were among the most likely people in the nation to have had a heart attack. Each of these 10 states was also among the top 10 for the percentage of people diagnosed with diabetes. In West Virginia and Mississippi, 16.6% and 15.9% of survey respondents had been diagnosed as diabetic, second and third most nationally.

Based on figures published by the Gallup-Healthways Well-Being Index, 24/7 Wall St. identified the 10 states with the highest percentage of the population that was classified as obese, measured by their self-reported height and weight. We also reviewed other relevant figures from the study, including data on healthy behavior, access and health outcomes. Additionally, we also considered data from the U.S. Census Bureau’s 2012 American Community Survey on income and poverty. Data from the U.S. Department of Agriculture’s Economic Research Service on food access was also considered. Figures on heart disease deaths and life expectancy at birth, both as of 2010, are from the Kaiser Family Foundation.

These are America’s fattest states.

10. Oklahoma
> Pct. obese: 30.5%
> Pct. with high blood pressure: 34.0% (9th most)
> Pct. exercise regularly: 50.7% (16th least)
> Poverty rate: 17.2% (15th highest)

More than three in 10 Oklahomans were considered obese last year. Poor eating habits may be one factor. Slightly more than half of the state’s residents said they ate adequate portions of fruits and vegetables last year, the worst in the nation. Less than 59% of Oklahomans said they ate healthy on a daily basis in 2013, also among the worst nationally. The state’s high obesity rate may partly explain the prevalence of heart-related ailments in the state. In 2010, there were 235.2 deaths per 100,000 state residents, more than in any state except for Mississippi and Alabama. Also, a greater proportion of Oklahomans reported having previously had a heart attack than residents in any other state last year.

9. Kentucky
> Pct. obese: 30.6%
> Pct. with high blood pressure: 35.0% (7th most)
> Pct. exercise regularly: 50.5% (tied for 14th least)
> Poverty rate: 19.4% (5th highest)

Unhealthy habits contributed to obesity levels among Kentucky residents. More than 30% of Kentuckians smoked cigarettes last year, the highest rate in the nation. Studies show that smoking can both discourage and decrease the effectiveness of physical activity. Poor eating habits also likely contributed to the state’s high obesity rate. Only 58.5% of state residents ate healthy all day, worst in the nation. Like many states with high obesity rates, Kentucky had some of the lowest income and highest poverty rates. The state’s $41,724 median household income was the fifth lowest in the United States, and nearly one in five residents lived below the poverty level last year.

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8. Ohio
> Pct. obese: 30.9%
> Pct. with high blood pressure: 31.8% (16th most)
> Pct. exercise regularly: 49.3% (7th least)
> Poverty rate: 16.3% (20th highest)

Ohio residents generally reported having good access to health care services. Last year, 82% had a personal doctor and more than 87% had health insurance, both among the best rates nationwide. While access to physicians typically is a key predictor of obesity rates, according to Gallup’s Dan Witters, Ohio still had one of the highest obesity rates in the country. Like most of the states with high obesity rates, many state residents were unable to engage in age-appropriate activities due to health concerns. Adding to the health problems already caused by the high obesity rate is the state’s high smoking rate. About one-quarter of the population were smokers as of last year, more than all but a handful of states.

7. Tennessee
> Pct. obese: 31.3%
> Pct. with high blood pressure: 36.0% (5th most)
> Pct. exercise regularly: 49.2% (6th least)
> Poverty rate: 17.9% (11th highest)

Given the state’s high obesity rate, it is perhaps not surprising that residents were more likely to suffer from a range of health problems. Last year, 36% of people surveyed reported having high blood pressure, while 29.4% of respondents said they had high cholesterol, both among the highest in the country. Also, nearly 15% of those surveyed suffered from diabetes, and more than 5% of people had previously had a heart attack, both especially high rates. Like several states struggling with obesity, educational attainment rates were poor in Tennessee. Just 85.1% of adults had at least a high school diploma in 2012, among the worst.

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6. South Carolina
> Pct. obese: 31.4%
> Pct. with high blood pressure: 33.0% (12th most)
> Pct. exercise regularly: 49.7% (10th least)
> Poverty rate: 18.3% (9th highest)

South Carolina is another example of the close relationship between low income and obesity. More than 31% of state residents were obese, the sixth highest rate in the nation, while 18.3% lived below the poverty line last year, the ninth highest in the nation. Additionally, 21.3% of residents did not have enough money to buy food at all times last year, the highest percentage in the United States. Residents of the states suffered from numerous health problems often associated with being overweight. Some 33% of state residents had high blood pressure, among the worst in the nation, and 27.5% of residents suffered from recurring knee and leg pain, symptoms that can be linked to obesity.

5. Arkansas
> Pct. obese: 32.3%
> Pct. with high blood pressure: 36.8% (4th most)
> Pct. exercise regularly: 52.5% (25th most)
> Poverty rate: 19.8% (4th highest)

Arkansas residents suffered from more health problems linked to obesity than residents of most states last year. Nearly 37% of residents suffered from high blood pressure, and 13.4% of the population were diagnosed with diabetes, both among the highest rates in the nation. At least some of the blame lies in the residents’ unhealthy diets and poor habits. More than two out of every 10 people in the state smoked cigarettes, and only 54.6% of the population ate servings of fruits and vegetables at least four times a week, the sixth worst in the nation. As is the case with many states with high obesity rates, Arkansas residents earned less than the rest of country. The state had a poverty rate of nearly 20%, fourth-worst nationally, in 2012.

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4. Louisiana
> Pct. obese: 32.7%
> Pct. with high blood pressure: 35.7% (6th most)
> Pct. exercise regularly: 50.5% (tied for 14th least)
> Poverty rate: 19.9% (3rd highest)

Louisiana has had among the highest obesity rates since 2008. More than 32% of residents were considered obese last year, a higher rate than all but three other states. Like many states with high obesity rates, Louisiana is a relatively poor state. A typical Louisiana household earned $42,944 in 2012, considerably less than the national median income of $51,371 that year. One factor that likely contributed to the state’s high obesity rate is the residents’ limited access to quality food. Nearly 10% of Louisiana residents had poor access to grocery stores and farmers’ markets, the fourth highest among all states. Additionally, 17% of adults in the state did not have a high school diploma, the fourth highest percentage in the country. Studies show that people who lack a complete high school education tend to make less knowledgeable decisions when it comes to health choices.

3. Delaware
> Pct. obese: 34.3%
> Pct. with high blood pressure: 33.9% (10th most)
> Pct. exercise regularly: 46.5% (the least)
> Poverty rate: 12.0% (12th lowest)

Delaware’s population was the worst in the country at getting enough exercise, with just 46.5% reporting having exercised three times a week. This low level of physical activity may contribute to the state’s weight problem. Residents also did not eat particularly well, with less than 55% saying they ate enough fruits and vegetables at least four days a week last year, among the worst nationally. Unlike many other states with high obesity rates, Delaware residents were wealthier than most Americans in 2012. A typical Delaware household earned $58,415, among the most nationwide. The state, however, also boasts some of the highest health care costs in the country, which may explain residents’ poor health.

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2. West Virginia
> Pct. obese: 34.4%
> Pct. with high blood pressure: 41.1% (the most)
> Pct. exercise regularly: 47.1% (2nd least)
> Poverty rate: 17.8% (13th highest)

West Virginia led the nation in several obesity-related health issues. As many as 41% of respondents reported having high blood pressure and 34% reported high cholesterol levels, the highest in the nation. West Virginians were also more likely to report chronic pain — whether in the neck, back, knee or leg — than residents of any other state last year. And 23% of residents cited other conditions causing recurring pain, also the most in the country. Like many of the most obese states, West Virginians were among the nation’s poorest residents, with a median household income of just $40,196 in 2012, third lowest nationally. Low incomes and prevalent obesity may partly explain why West Virginians rated their lives poorly in Gallup’s Life Evaluation Index — nearly half of all respondents said they were struggling last year, the most nationwide.

1. Mississippi
> Pct. obese: 35.4%
> Pct. with high blood pressure: 40.6% (2nd most)
> Pct. exercise regularly: 50.1% (11th least)
> Poverty rate: 24.2% (the highest)

Mississippi has been among America’s most obese states since Gallup started collecting data in 2008. The high obesity rate has had clear adverse effects on the health of the state’s residents. Chronic health issues often associated with obesity, such as high blood pressure, high cholesterol and headaches, were all common among state residents. Also, as is often the case with obese populations, Mississippi residents were more likely to suffer from diabetes. More than 16% of residents reported they had been diagnosed with diabetes as of last year, the second-highest rate nationally. Residents also had the lowest life expectancy in the nation, at just 75 years. Poor educational attainment, which may lead to poor health choices, also leads to relatively lower incomes. Just 82.3% of adults had a high school diploma in 2012, among the worst rates in the nation. And nearly one-quarter of Mississippi residents lived below the poverty line in 2012, worse than in every other state.

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