Obesity in the United States is a significant problem. According to the Centers for Disease Control and Prevention, more than a third of adults in the U.S. are obese. That comes out to 78 million Americans.

Read: America’s Most Obese States

Obesity is also costly. As of 2008, it was estimated to cost the U.S. roughly $147 billion annually. Medical costs alone for each obese person were $1,429 more a year than those of healthy weight.

Between health risks and costs of care, the differences should encourage states to address the obesity epidemic. Based on the CDC’s Behavior Risk Factor Surveillance System (BRFSS) data, 24/7 Wall St. identified the 11 states with the highest obesity rates.

Obesity has been commonly tied to several groups, including low-income families and those with lower levels of higher education. While the relationship between these groups remains the subject of debate, most experts agree that they’re related. Nine of the 11 states with the highest obesity rates are in the top fifteen for poverty rates. Of those 11, nine are in the bottom third for median income. All five of the states with the lowest median income — Alabama, Kentucky, Arkansas, West Virginia, and Mississippi, are on the list.

The major health risks associated with obesity, including type 2 diabetes, stroke, certain types of cancer, and heart disease, are some of the leading causes of preventable death. Of the 11 states with the highest self-reported obesity rates in the country, seven have among the highest death rates from heart disease, and nine are in the top one-third for both diabetes and stroke incidences.

Some areas of the country tend to suffer more from obesity than others.. Almost every state with 30% obesity or greater is in the South, with the exception of Indiana and Michigan. Three of the four worst states — Mississippi, Louisiana, and Alabama — are all adjacent to each other on the Gulf of Mexico.

Last week, Gallup released its own obesity survey, which breaks down weight into more classes according to body mass index (BMI) categories. BMI is a calculation that takes into account a person’s height and weight. Overweight adults have a BMI of 25 to 29.99, and obese adults have a BMI of 30 or higher. The Gallup study, which was conducted over the first half of 2012, provides figures for the rate of obesity and overweight adults. Of the 11 states on our list, nine are in the top one-third with the highest combined overweight/obesity rate, including West Virginia, where nearly 70% adults fall into one of those two categories.

24/7 Wall St. examined the recent study released by the CDC’s Behavioral Risk Factor Surveillance System to identify the 11 states which had the highest proportion of self-reported obesity among adult. 24/7 Wall St. also reviewed CDC data on obesity rates by state in 1996, as well as stroke prevalence by state in 2010. We relied on The Henry J. Kaiser Family Foundation’s statehealthfacts.org for a variety of data related to health at the state level, including 2010 smoking, diabetes , medicare and life expectancy statistics. The Census Bureau provided information on median income by state, also for 2010. Gallup’s obesity poll, conducted for the first six months of 2012, looked at the percentage of adults that are overweight (BMI 20-30), or Obese types I, II, or III (BMI 30-34.99, 35-39.99, and 40 or more)

11. Texas (tied for 10th)
> Self-reported obesity rate: 30.4%
> Diabetes rate: 9.7% (16th highest)
> Life expectancy: 78.27 years (21st lowest)

According to the CDC, 30.4% of Texans reported they were obese in 2011, tied with Kentucky for the 10th highest rate in the country. In 1996, the obesity rate in Texas was 16.7% — the 19th highest in the U.S. at the time. In 2011, the Lone Star state also had the highest percentage of uninsured adults and children in the country at 33% and 17%, respectively. The state also had one of the lowest percentages of Medicare beneficiaries, at 12%. Texas had the 16th- and 12th-highest rates of diabetes and strokes respectively in 2010.

Also Read: America’s Most (and Least) Liveable States

10. Kentucky (tied for 10th)
> Self-reported obesity rate: 30.4%
> Diabetes rate: 10.0% (13th highest)
> Life expectancy: 76.19 years (7th lowest)

Kentucky ties with Texas for the 10th highest obesity rate. In 1996, Kentucky had the fifth-highest obesity rate. While this is an improvement from 1996 when Kentucky had the fifth-highest rate, the obesity rate itself increased significantly. The Bluegrass state had the second highest invasive cancer rate in the country in 2007 at 517.5 cases per 100,000 people — much higher than the national average of 465.1 cases per 100,000 persons. Kentucky also had the second highest rate of smokers in the country after West Virginia. Of the state’s adult population, 24.8% were smokers in 2010, 44% more than the national rate of 17.2%. In 2008, Kentucky had the sixth-highest death rate in the country, at 902.4 deaths per 100,000 individuals.

9. South Carolina (tied for 8th)
> Self-reported obesity rate:  30.8%
> Diabetes rate: 10.7% (6th highest)
> Life expectancy: 76.57 years (9th lowest)

South Carolinians tied for the eighth-heaviest state in the country. They also had the fifth-highest rate of strokes in the country in 2010, at 3.4%. State residents have some of the worst nutrition in the country as well. The state ranked tenth-lowest for the percentage of adults who consumed two pieces of fruit, and first-lowest for those who consumed three vegetables a day in 2009. According to the Gallup-Healthways Well-Being Index for 2012, 40% of South Carolinian adults were classified as overweight, the second-largest percentage in the country and 10% more than the national average.

8. Indiana (tied for 8th)
> Self-reported obesity rate:  30.8%
> Diabetes rate: 9.8% (14th highest)
> Life expectancy: 77.71 years (16th lowest)

Indiana is one of two Midwest states on this list, along with Michigan. In 1996, the state was ranked 11th in the country for its rate of obesity at 17.9%. According to the Gallup study on obesity for 2012, Indiana had the fourth largest percentage of individuals who have level two obesity, which means a BMI between 35% and 40%. Like many of the states in the top 11, Indiana had a high prevalence of smokers in 2010, at 21.2%. This is 23% higher than the national rate of 17.2%.

7. Arkansas
> Self-reported obesity rate:  30.9%
> Diabetes rate: 9.6% (18th highest)
> Life expectancy: 76.09 years (6th lowest)

Arkansas jumped up the ranks for its rate of obesity from 15th in the country in 1996 to seventh in 2011. Despite being in the top 11 of states with the most obese residents, Arkansas is in the bottom 10 of states with the largest proportion of overweight individuals, classified as having a BMI below 30% but above 25%. The state’s rate of children on Medicaid benefits was 45% in 2010, the second highest rate in the country. Also, 27% of adults in the state were uninsured in 2010 — the sixth highest in 2012, at 3.4%. Almost 23% of Arkansans smoked in 2010, the fourth highest rate in the country.

Also Read: The Most Dangerous States for Pedestrians

6. Oklahoma
> Self-reported obesity rate:  31.1%
> Diabetes rate: 10.4% (7th highest)
> Life expectancy: 75.60 years (5th lowest)

In Oklahoma, 31.1% of adults reported they were obese. The state also ranked third-highest in smoking rate among adults at 23.7%. As of 2010, the Sooner state had the second highest rate of heart disease deaths in the country and the second highest rate of strokes among adults in the population. The state also ranked third, as of 2008, for the number of deaths annually per 100,000 people with 931 deaths. The national rate was 758.3 deaths per 100,000 people in the population. Oklahoma also had the fourth highest rate of class II obesity at 7.3% of adults, and the eighth highest rate of class III obesity, classified as a BMI over 40%, at 4.2%, according to the Gallup study.

5. Michigan
> Self-reported obesity rate: 31.3%
> Diabetes rate:10.1% (11th highest)
> Life expectancy: 77.89 years (17th lowest)

In addition to being one of the most obese states in the nation, Michigan also has among the 10-highest rates of deaths related to heart disease. In 2008, the state had 220.3 deaths related to heart diseases per 100,000 individuals. The national rate was 186.5 deaths per 100,000 individuals. Michigan also ranked 11th in the country for the percentage of residents who have been told by a doctor that they have diabetes. Despite the high prevalence of obesity, like Arkansas, Michigan falls in the bottom 10 of states for the proportion of overweight individuals. In fact, Michigan ranked third lowest for the number of individuals classified as overweight according to the recent Gallup study.

Also Read: States With the Least Full-time Work

4. Alabama
> Self-reported obesity rate:  32%
> Diabetes rate:13.2% (highest)
> Life expectancy: 75.18 years (3rd lowest)

In 1996, Alabama led the country in the percentage of obese people at 19.8%. While its ranking improved somewhat, the prevalence of obesity in the state rose significantly. The state leads the country in the percentage of adults who have been told by their doctor that they have diabetes at 13.2% — much higher than the national rate of 8.7%. Alabama also leads the country in the percentage of adults who have had a stroke, at 4.1%. In 2008, the state was third in the country for the most number of deaths related to heart disease per 100,000 people. The median income in Alabama is the fifth-lowest in the country at $40,474.

3. West Virginia
> Self-reported obesity rate: 32.4%
> Diabetes rate: 11.7% (3rd highest)
> Life expectancy: 75.16 years(2nd lowest)

On top of having the third-highest obesity rate in the country, West Virginia also has the third-highest rate of adults who have been told by a doctor that they have diabetes. The Mountain state led the country for the number of deaths annually per 100,000 people with 958.5 deaths in 2008. The national rate was 758.3 deaths. West Virginia also led the country in smoking rate, with 26.8% of adults smoking in 2010, or 56% more than the national rate of 17.2%. Similarly, 21% of the population received Medicare benefits, the highest figure in the country, and much higher than the national rate of 15%.

2. Louisiana
> Self-reported obesity rate: 33.4%
> Obesity rate: 19.3% (2nd highest)
> Life expectancy: 75.39 years(4th lowest)

In 1996, Louisiana ranked second in the country for its obesity rate among adults. More than 15 years later and the state remains in second place. The median income in Louisiana is the 10th lowest in the country. The infant mortality rate in the Bayou state was 42% higher than the national rate in 2010, ranking as the second worst in the country. Louisiana ranked seventh in the country for the percentage of residents who classify as having class I obesity, classified as a BMI greater than 30% but less than 35%, at 18.3%.

Also Read: States That Get the Most Federal Money

1. Mississippi
> Self-reported obesity rate: 34.9%
> Diabetes rate: 12.4% (2nd highest)
> Life expectancy: 74.81 years (lowest)

Nearly 35% of adults in Mississippi reported they were obese in 2011 — more than any other state. The Magnolia state leads the country in a number of other areas as well. As per the most recent data, Mississippi had the highest rate of deaths due to heart disease at 260.2 deaths per 100,000 persons; it had the greatest percentage of children on Medicaid at 47%; and it had the highest infant mortality, at 10.64 deaths per 1,000 live births. Life expectancy in the state is the lowest in the country at 74.81 years, nearly four years lower than the national expectancy of 78.6 years. Mississippians also have the lowest median income in the country at $36,851, or less than 74% of the national median income of $50,046.

-Michael Sauter and Lisa Uible

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