While most Americans can choose what they want to eat each day, in many regions that choice is considerably limited. A range of direct and indirect factors, including income, food availability and education, can shape eating habits. In some parts of the country, diets are particularly unhealthy.

Based on data from Gallup-Healthways Well-Being Index, the U.S. Census Bureau, and the U.S. Department of Agriculture (USDA), 24/7 Wall St. created an index of six measures to evaluate the regional diets of large American cities. The New Orleans metro area has the least healthy overall diet among all areas reviewed.

According to Dan Witters, research director at Gallup, while there are a complex array of factors contributing to diet, low income is the best predictor of poor eating habits. All but one of the metro areas with the worst diets had poverty rates well above the national rate of 15.9%. The McAllen, Texas, metro area was among the cities with the worst diets and also led the nation with 34.5% of residents living below the poverty line in 2012.

As a consequence, residents of the cities on this list struggle to even buy food. Exceptionally low proportions of residents in all these metro areas told Gallup they had enough money to buy food in the past 12 months.

Another major driver of unhealthy eating habits is the access residents have to fresh, healthy and affordable food. The USDA classifies low-income communities without access to such foods as food deserts. Witters explained that in the absence of close and affordable access to healthy food, people rely on alternatives such as fast food, which may be cheaper in some cases. In the New Orleans metro area, 50 communities were identified as food deserts as of 2010.

While affordability and access are the primary drivers of a particular diet, education also informs healthy lifestyles. “Lower-income people have a lower probability of being exposed to the health risks of poor eating habits and therefore are less conscious and sensitive to these realities and the choices that they make,” Witters said. In all but two of the metro areas with the worst diets, less than 30% of adult residents — roughly the national rate — had at least a bachelor’s degree in 2012.

According to Witters, low-incomes, poor access, inadequate health literacy and the associated poor diets result in a variety of negative health outcomes. With the exception of Springfield, Mass., obesity rates were higher than the national rate in all the metro areas with the worst diets.

Obesity, in turn, is associated with a number of other ailments. “The cities with higher obesity rates generally have higher diabetes rates,” Witters explained. “You’re also going to have things like heart attack,” he added, as well as “high cholesterol, and blood pressure.”

To identify the 11 cities with the worst diets, 24/7 Wall St. generated an index score from six different measures. The percentages of residents who ate five servings of fruits and vegetables at least four days in the previous week, had easy access to healthy food and who said they could afford food all came from the 2013 Gallup-Healthways Well-Being Index. The percentage of households relying on food stamps came from the Census Bureau. Food desert and grocery store access data came from the USDA. In addition to the six index components, we reviewed fast-food restaurants per 100,000 residents from the USDA, as well as health outcomes like obesity and diabetes rates from Gallup. All data are from the most recent period available.

These are the cities with the most dangerous diets.

11. Baton Rouge, La.
> Poverty rate: 18.7% (28th highest)
> Pct. households on food stamps within past 12 months: 15.9% (44th highest)
> Pct. obese: 29.0% (50th highest)
> Pct. unable to afford fruits/veggies: 8.3% (tied, 74th highest)

Baton Rouge residents had among the least healthy diets in America. Like other areas where people eat very poorly, poverty likely hampers most residents’ ability to access high-quality food. Nearly 19% of area residents lived below the poverty line in 2012, versus a national poverty rate of 15.9%. Last year, just 58.6% of survey respondents told Gallup they ate healthy all of the previous day, among the lowest percentages of any metro area reviewed. Households in Baton Rouge were also more likely than most Americans to rely on food stamps in 2012.

10. Corpus Christi, Texas
> Poverty rate: 16.2% (74th highest)
> Pct. households on food stamps: 15.4% (52nd highest)
> Pct. obese: 32.6% (12th highest)
> Pct. unable to afford fruits/veggies: 8.9 % (tied, 45th highest)

More than 32% of Corpus Christi area residents were obese last year. Seventeen percent of residents surveyed had been diagnosed with diabetes last year, one of the highest rates in the nation and well above the national rate of 11.1%. Further, 34.4% noted they had health issues preventing them from participating in their usual activities. These poor health outcomes were likely due in part to the high number of urban and rural neighborhoods without ready access to nutritious, healthy food. Twenty-three communities in the metro area were classified as food deserts and more than 30% of the population had low access to a grocery store in 2010. The following year, there were only seven grocery stores in Corpus Christi for every 100,000 residents, the second lowest rate on our list. According to Feeding America’s 2013 “Mapping the Meal Gap” report, nearly 13% of children in Corpus Christi lived in food insecure households, defined as households unable to provide adequately nutritious food.

9. McAllen-Edinburg-Mission, Texas
> Poverty rate: 34.5% (the highest)
> Pct. households on food stamps: 32.7% (the highest)
> Pct. obese: 38.3% (2nd highest)
> Pct. unable to afford fruits/veggies: 8.3% (tied, 74th highest)

Nearly 35% of residents in the McAllen area lived below the poverty line in 2012, more than double the national rate and more than any other metro area reviewed. Like a majority of metro areas with the worst diets, fast-food restaurants were far more numerous than grocery stores. Even if healthy food were available in the region, residents were often unable to afford it. Just 70.6% of residents said they had enough money to buy food at all times in the 12 months prior to Gallup’s 2013 survey, less than every area reviewed except for Columbus, Ga. Nearly a third of households relied on food stamps in 2012, the highest percentage nationwide. Like many areas in Texas, McAllen-area residents also suffer from obesity. Nearly 40% of residents in the McAllen area were classified as clinically obese by Gallup last year, the second-highest obesity rate in the nation.

8. Beaumont-Port Arthur, Texas
> Poverty rate: 19.1% (26th highest)
> Pct. households on food stamps: 17.0% (29th highest)
> Pct. obese: 31.2% (21st highest)
> Pct. unable to afford fruits/veggies: 10.4% (20th highest)

While income and physical proximity to healthy food are perhaps the most important contributors to food security and healthy diets, education also plays a major role. Just 17.1% of Beaumont area residents had completed at least a bachelor’s degree in 2012, far less than the national rate of nearly 30%. Poor eating habits likely led to higher proportions of residents suffering from poor health outcomes. Nearly 16% were diagnosed with diabetes last year, for example, among the highest rates in the nation. A higher incidence of poor health outcomes like diabetes associated with unhealthy behaviors and dietary habits. More than 31% of residents were clinically obese last year, among the higher rates.

7. El Paso, Texas
> Poverty rate: 24.0% (5th highest)
> Pct. households on food stamps: 24.6% (4th highest)
> Pct. obese: 29.3% (46th highest)
> Pct. unable to afford fruits/veggies: 8.9% (tied, 45th highest)

Low income families in El Paso likely struggle to maintain a healthy diet. Nearly a quarter of the population lived below the poverty line in 2012, a higher rate than all but four metro areas reviewed. Similarly, nearly a quarter of households used food stamps, while still only three-quarters of people surveyed had enough money to buy food at all times throughout the past 12 months. Although 91% of respondents reported that it was easy to obtain affordable fruits and vegetables, only 53.2% of respondents said they ate five servings at least four days a week, one of the lowest proportions on the list. Just over 65% of residents had health insurance, considerably less than the national rate of 82.5%.

6. Springfield, Mass.
> Poverty rate: 17.2 % (52nd highest)
> Pct. households on food stamps: 19.5% (12th highest)
> Pct. obese: 24.6% (57th lowest)
> Pct. unable to afford fruits/veggies: 9.3% (38th highest)

A typical household in Springfield earned $51,531 in 2012, the only area among other metro areas with poor diets with income exceeding the national median of $51,371. Residents also benefit from the state’s exceptional health care system. Ninety-two percent had a personal doctor, and 95% had health insurance, among the highest rates nationwide. Still, nearly 20% of households relied on food stamps, among the higher rates nationwide. Limited access to grocery stores also likely contributed to lower food security. More than 28% of Springfield residents had low access to stores in 2010, among the higher proportions in the country. Unlike most metro areas with poor diets, Springfield had a low obesity rate, at 24.6% last year — less than the national rate of 27.1%

5. Jackson, Miss.
> Poverty rate: 22.2% 11th highest
> Pct. households on food stamps: 16.2% (35th highest)
> Pct. obese: 33.8% (8th highest)
> Pct. unable to afford fruits/veggies: 12.0% (11th highest)

Poor access to healthy food may be just one of Jackson residents’ worries, as high numbers of people living in the area struggle to find other basic needs. More than 22% of the population within the metro area lived below the poverty line in 2012. Last year, some 16% of respondents said that they did not have enough money for adequate shelter at some point in the past 12 months, one of the worst rates in the nation. Nearly 10% of respondents felt they could not easily obtain clean and safe water, also one of the worst rates in the nation. Although Jackson area residents had higher rates of educational attainment than other metro areas on this list, the typical household’s income was still very low, at $42,604 in 2012.

4. Mobile, Ala.
> Poverty rate: 21.1% (13th highest)
> Pct. households on food stamps: 21.6% (7th highest)
> Pct. obese: 31.3% 20th highest
> Pct. unable to afford fruits/veggies: 9.6% (31st highest)

Like much of the southern United States, poverty has led to poor eating habits and negative health outcomes in the Mobile metro area. A typical household in the region earned less than $40,000 in 2012, among the lowest median household incomes in the nation. Just 72.8% of survey respondents told Gallup last year they had enough money to buy food in the previous 12 months, nearly the lowest percentage among metro areas reviewed. Mobile residents also suffered from exceptionally high rates of negative health outcomes. More than 31% were considered obese, and 13.3% were diagnosed with diabetes in 2013, both among the worst measures of physical health.

3. Columbus, Ga.-Ala.
> Poverty rate: 18.7 % (28th highest)
> Pct. households on food stamps: 20.6% (9th highest)
> Pct. obese: 32.5% (13th highest)
> Pct. unable to afford fruits/veggies: 13.6% (6th highest)

While nearly 81% of Americans told Gallup they had enough money for food, just 67.1% of Columbus residents said the same, the lowest percentage among metro areas reviewed. More than 20% of households relied on food stamps in 2012, and only 57.3% of residents told Gallup they ate healthy all day last year, among the lowest percentages. Like most regions with poor diets, Columbus residents had exceptionally low rates of educational attainment. Just 21.9% had completed at least a bachelor’s degree in 2012, among the lower rates in the country.

2. Shreveport-Bossier City, La.
> Poverty rate: 18.1% (35th highest)
> Pct. households on food stamps: 16.1% (38th highest)
> Pct. obese: 30.7% (29th highest)
> Pct. unable to afford fruits/veggies: 11.5% (13th highest)

The Shreveport-Bossier metro area has 30 food deserts — defined as areas where people have low income and little access to healthy food — making it extremely difficult for residents to consume a healthy diet. Residents likely find it very difficult to afford healthy foods such as fruits and vegetables, as more than 16% of households relied on food stamps in 2012. Also, the median household income in the Shreveport metro area was $44,118 in 2012, well below the national median. Notably, 23.6% of people felt that they did not have enough money to buy necessary food items at all times last year.

1. New Orleans-Metairie-Kenner, La.
> Poverty rate: 14.6% (66th lowest)
> Pct. households on food stamps: 17.1% (28th highest)
> Pct. obese: 28.7% (54th highest)
> Pct. unable to afford fruits/veggies: 9.8% (26th highest)

Residents of the New Orleans metro area have the most unhealthy diets among U.S. cities. Area residents were more likely to suffer from a number of negative health outcomes than the average American, including diabetes, high blood pressure and obesity. Like most metro areas with poor diets, eating habits are likely related to economic factors. Just around three-quarters of survey respondents told Gallup last year they had enough money to buy food in the past 12 months, among the lower rates for areas reviewed. And area households were far more likely than Americans to rely on food stamps. Access and proximity to healthy food is another factor contributing to unhealthy diets. The USDA classified 50 communities in the region as food deserts, a higher figure than in every other area on this list.

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