Obesity in the United States continues to rise, and the problem does not appear to be getting any better. According to the Centers for Disease Control and Prevention, the national obesity rate rose again in 2013 to 28.3% of the adult population. The growing epidemic is placing an increasingly greater burden on our health care system, and according to a 2013 study, the annual obesity-related health care costs are estimated to be as high as $210 billion.

Based on the Centers for Disease Control and Prevention data on obesity, 24/7 Wall St. reviewed the 10 states with the highest and the 10 states with the lowest obesity rates in 2013. West Virginia and Mississippi tied for the worst obesity rates in the country at just over 35% of adults. Colorado remained the state with the least severe problem, with an adult obesity rate of 21.3%.

Click here to see the states with the highest obesity rates.

Click here to see the states with the lowest obesity rates.

Obesity is a complicated issue, and a wide range of factors can contribute to the problem in a given area. Diet, not surprisingly, plays a major role. All but one of the 10 states with the highest obesity rates were in the bottom 10 for daily fruit consumption, and adults in all of the 10 states were less likely than the average American to eat vegetables on a daily basis. The data show that exercise is just as important as diet. The nine states with the lowest rates of physical activity had the nine highest rates of obesity.

Diet and exercise, however, are not the only elements that can affect obesity rates. The CDC explains that a variety of social and economic factors also can contribute to high obesity rates. For example, lower-income families are less likely to be able to afford healthy foods. Each of the states with the highest obesity rates had above-average poverty rates.

Education also has been shown to be a factor in health decisions and outcomes. A more educated population is more likely to be aware of the importance of healthy choices. And people with better education are also more likely to have higher-paying jobs and live in areas where they can have access to healthy food and safe exercise options. Nationally, just under 30% of adults had a bachelor’s degree or higher. In all but one of the 10 states with the highest obesity rates, less than 25% adults had a such an education.

While obesity is itself defined as a negative health outcome, it is also linked to other health conditions, including high blood pressure, diabetes, heart disease, and even some forms of cancer. In states where obesity is lower, these health outcomes are much less prevalent. All but one of the 10 states with the lowest obesity rates had below-average rates of high blood pressure. Rates of diabetes, high cholesterol, and heart disease-related deaths were also below average in nearly all of the states with the lowest obesity rates.

If obesity rates continue to increase, it is the states with already nearly a third of the population facing obesity that will likely experience the most severe consequences. If the problem continues to worsen, rates of serious health problems in states such as Mississippi and West Virginia will certainly rise, and the costs for treating these conditions will continue to pile on.

To determine the states with the highest and lowest obesity rates, 24/7 Wall St. reviewed obesity rates for 2013 from the Centers for Disease Control and Prevention (CDC). We also examined obesity rates for 2011 and 2012 from the same survey. Also from the CDC, we considered the percentage of people in each state who reported consuming fruits and vegetables daily in 2011, as well as the median daily intake of fruits and vegetables. Cancer rates and high blood pressure rates per 100,000 people also came from the CDC and are for 2011. Additionally, the percentage of adults diagnosed with diabetes in 2012 comes from the CDC. Data on cholesterol and heart disease per 100,000 people in 2013 come from the Kaiser Family Foundation. From the U.S. Census Bureau’s 2013 American Community Survey, we looked at high school and bachelor’s degree educational attainment rates, median household income, and poverty rates. The percentage of adults that are physically inactive come from County Health Rankings & Roadmaps.

The States With the Highest Obesity Rates

10. South Carolina
> Obesity rate: 31.7%
> Pct. physically inactive: 25.6% (12th highest)
> Pct. diabetic: 12.0% (5th highest)
> Poverty rate: 18.6% (8th highest)

Nearly 32% of South Carolina adults were obese in 2013, the 10th highest rate nationwide. As in most states with the highest obesity rates, South Carolina residents were among the least likely to consume fresh produce on a regular basis. More than 27% of residents reported less than daily vegetable consumption, and 44.4% reported less than daily fruit consumption, the fourth and eighth highest percentages in the country, respectively. The relatively poor eating habits among residents may have contributed to the high obesity rate in the state, which in turn may have led to poor health outcomes. While 31.4% of Americans had high blood pressure, more than 38.4% of South Carolina residents suffered from the condition.

ALSO READ: The Least Healthy County in Each State

9. Indiana
> Obesity rate: 31.8%
> Pct. physically inactive: 26.8% (9th highest)
> Pct. diabetic: 10.8% (11th highest)
> Poverty rate: 15.9% (22nd highest)

Indiana’s obesity rate has hovered between 30% and 32% in each of the past three years. Although high poverty rates and obesity rates tend to go hand-in-hand, the state’s poverty rate of 15.9% was only slightly higher than the national rate. Dietary choices may be a factor in the state’s obesity problem. Of the state’s adults surveyed, 27.3% reported eating vegetables less than once per day, tied for fourth-worst in the nation. Citing the obesity epidemic in the state, Indiana’s House Speaker Brian Bosma recently drafted a measure to support “Change The Play” program. The program intends to improve childhood obesity by encouraging physical activity and healthier food choices.

8. Alabama
> Obesity rate: 32.4%
> Pct. physically inactive: 29.4% (7th highest)
> Pct. diabetic: 12.9% (2nd highest)
> Poverty rate: 18.7% (7th highest)

Low incomes are tied to poor health outcomes. Not only do higher-paying jobs tend to offer better benefits such as health insurance, but also lower income Americans frequently live in areas with limited access to healthy foods and grocery stores. Like most states with the highest obesity rates, Alabama’s median household income of $42,849 was nearly the lowest in the country. Poor diets likely contributed to Alabama’s eighth-highest obesity rate of 32.4%, as well as to the nation-leading 44.4% of area residents reporting high cholesterol.

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7. Oklahoma
> Obesity rate: 32.5%
> Pct. physically inactive: 30.0% (5th highest)
> Pct. diabetic: 11.5% (9th highest)
> Poverty rate: 16.8% (16th highest)

Poor eating habits have likely been a factor in Oklahoma’s outstanding obesity issues. The state’s fruit and vegetable intakes were among the lowest in the country. A lack of exercise was also likely a factor in the state’s high obesity rate. In Oklahoma, 30% of residents reported being generally physically inactive, higher than the 23% of physically inactive Americans. The poor health choices and high obesity rate likely contributed to poor health outcomes among state residents. The prevalences of high blood pressure and high cholesterol among state residents were among the highest in the country. And the state had the second-highest rate of heart disease-related deaths in the U.S.

6. Louisiana
> Obesity rate: 33.1%
> Pct. physically inactive: 29.9% (6th highest)
> Pct. diabetic: 12.1% (4th highest)
> Poverty rate: 19.8% (3rd highest)

Low educational attainment rates in Louisiana may partly account for the state’s high obesity rate of 33.1%. A good education can improve health literacy and offer better job prospects, both of which can pave the way to healthier lifestyles. In Louisiana, however, 83.1% had completed at least high school and 22.5% had at least a bachelor’s degree, each nearly the lowest rates, respectively, of all states. Residents reported relatively poor eating habits. While less than 23% of Americans consumed vegetables less than once a day, as many as 32.5% of Louisiana residents reported such low vegetable intake — the highest rate in the country.

5. Kentucky
> Obesity rate: 33.2%
> Pct. physically inactive: 29.1% (8th highest)
> Pct. diabetic: 11.8% (7th highest)
> Poverty rate: 18.8% (6th highest)

Like many states, Kentucky’s obesity problem has worsened in recent years. The adult obesity rate increased from 30.4% in 2011 to 33.2% in 2013. Things are even worse for the state’s young adults. Among the Oklahoma’s ninth- through 12th-graders, 18% were obese, more than any state in the country. High obesity rates are associated with a variety of poor health outcomes, including high blood pressure and diabetes. In Kentucky, 39.1% of adults had high blood pressure, the fifth-highest proportion in the country, and 43.2% of adults had high cholesterol, second-worst in the country.

4. Tennessee
> Obesity rate: 33.7%
> Pct. physically inactive: 30.3% (4th highest)
> Pct. diabetic: 12.0% (5th highest)
> Poverty rate: 17.8% (12th highest)

As in every other state with nation-leading obesity rates, Tennessee residents were far less likely to exercise regularly than most Americans. More than 30% said they did not exercise at all in the past 30 days, the fourth highest share in the country. Also similar to other high-obesity states, Tennessee also had a relatively high concentration of fast food restaurants such as McDonald’s. A high prevalence of fast food restaurants does not necessarily lead to poor health outcomes and obesity, but it is often representative of fewer available healthy choices. In many areas of the state, residents had limited access to healthy food options, which partly explains the residents’ low fruit and vegetable intake. More than 46% of state residents reported eating fruit less than once a day, the sixth highest share nationwide.

ALSO READ: The Least Healthy County in Each State

3. Arkansas
> Obesity rate: 34.6%
> Pct. physically inactive: 30.5% (3rd highest)
> Pct. diabetic: 11.7% (8th highest)
> Poverty rate: 19.7% (4th highest)

Arkansas’ obesity rate has worsened in recent years. The proportion of obese adults rose from 30.9% in 2011 to 34.6% in 2013. One factor that will likely make it harder for the state to combat this trend is the low rate of physical activity among the population. More than 30% of state residents reported no recent physical activity, third-worst in the country. Kentucky’s obesity problem is likely exacerbated by poor diet as well: 47.5% of adults consumed fruit less than once per day, and 28.6% of adults consumed less than one vegetable per day, each third-worst in the nation.

1. Mississippi
> Obesity rate: 35.1%
> Pct. physically inactive: 32.5% (the highest)
> Pct. diabetic: 13.5% (the highest)
> Poverty rate: 24.0% (the highest)

Mississippi’s obesity rate of 35.1% was tied with West Virginia for the highest obesity rate in the country. As in most states with the highest obesity rates, poor socioeconomic factors play a significant role in determining the unhealthy lifestyles in Mississippi. The state’s poverty rate of 24% was the highest in the country, and a typical household earned less than $40,000 annually, the lowest median household income nationwide. Nearly 51% of state residents reported consuming fruits less than once daily, and 32.5% said they did not exercise at all in the past 30 days, both the highest percentages in the country. Unhealthy behaviors such as these contributed to the obesity rate, which in turn helped lead to other poor health outcomes. There were 240 heart disease-related deaths per 100,000 Mississippians, for example, the highest rate compared to all states.

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1. West Virginia
> Obesity rate: 35.1%
> Pct. physically inactive: 32.5% (2nd highest)
> Pct. diabetic: 12.9% (2nd highest)
> Poverty rate: 18.5% (10th highest)

West Virginia moved from fourth in the nation to first, based on the most recent year of obesity data, tying Mississippi for the highest obesity rate. A good education has been linked to lower rates of obesity among a population. However, West Virginia had one of the worst educational attainment rates in the country. Only 18.9% of the state’s adults had a bachelor’s degree or higher, more than 10 percentage points lower than the national rate. West Virginia also has the second-lowest rate of physical activity reported among adults, which has also likely contributed to the state’s obesity problem. State residents suffer from many of the health problems associated with obesity. West Virginia had the third-highest rate of high cholesterol, is tied for the second-highest rate of diabetes, and has relatively more adults with high blood pressure than in any other state.

Click here to see the states with the lowest obesity rates.

The States With the Lowest Obesity Rates

10. Minnesota
> Obesity rate: 25.5%
> Pct. physically inactive: 19.3% (8th lowest)
> Pct. diabetic: 7.6% (6th lowest)
> Poverty rate: 11.2% (7th lowest)

While more than 28% of Americans were obese in 2013, just over one-quarter of Minnesota residents were, the 10th lowest obesity rate nationwide. As in many other states, the low obesity rate in Minnesota is associated with a low incidence of several other negative health outcomes, many of which can be direct consequences of unhealthy weight gain. There were just 119.6 heart-related deaths per 100,000 Minnesota residents, for example, the lowest rate nationwide. In addition, state residents were relatively well-educated and had relatively high incomes, factors that help pave the way towards a healthy lifestyle. More than 92% of adults had completed at least high school, and the median household earned $60,702 annually, both among the highest figures in the country.

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9. New York
> Obesity rate: 25.4%
> Pct. physically inactive: 23.5% (24th highest)
> Pct. diabetic: 9.4% (23rd highest)
> Poverty rate: 16.0% (20th highest)

One factor contributing to the state’s low obesity rate may be New York City, which represents more than 40% of the state population. The city’s residents tend to be healthier than the average American. There are many potential reasons for this, including healthier habits and exercise. More than 10% of the city’s population walks to work, third-most among major U.S. cities. The state, however, has higher rates of many health issues normally associated with high-obesity states. Adults reported the ninth-lowest obesity rate but the 14th-highest rate of heart disease-related deaths. New York is in the midst of a long-term plan to reduce preventable deaths, and fighting obesity is an integral part of the plan.

8. Connecticut
> Obesity rate: 25.0%
> Pct. physically inactive: 21.7% (18th lowest)
> Pct. diabetic: 8.5% (14th lowest)
> Poverty rate: 10.7% (4th lowest)

High incomes in Connecticut improved access to medical care and likely provided residents with more healthy lifestyles options. The state’s median household income of $67,098 was the fifth highest in the country. Similarly, just as the challenges of living in poverty can lead to poor health outcomes, the relatively low poverty rate of 10.7% in Connecticut likely helped lower incidence of such outcomes across the state. There were about 216 cardiovascular deaths between 2010 and 2012 in the state, for example, one of the lowest figures nationwide. In addition, like many other states with the lowest obesity rates, Connecticut residents had relatively healthy diets. While nearly 38% of Americans reported eating fruit less than once a day, only 32% of Connecticut residents reported such low fruit intake, the sixth lowest such percentage.

7. Vermont
> Obesity rate: 24.7%
> Pct. physically inactive: 18.4% (7th lowest)
> Pct. diabetic: 7.6% (6th lowest)
> Poverty rate: 12.3% (12th lowest)

Healthy diets and exercise helped lower the incidence of obesity in Vermont. Just over 18% of Vermonters reported eating vegetables less than once a day, nearly the lowest percentage in the nation. Also, just 18.4% did not participate in any exercise activity in the past 30 days, also one of the lowest such percentages. Nearly 36% of adults in the state had completed at least a bachelor’s degree — one of the highest attainment rates compared with other states, which likely helped improve health literacy and lower the likelihood of unhealthy weight gain. While the low obesity rate among Vermonters accompanied a lower incidence of other negative health outcomes, the state’s cancer death rate of 195.6 per 100,000 people was exceptionally high compared with other states on this list.

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6. Montana
> Obesity rate: 24.6%
> Pct. physically inactive: 22.0% (19th lowest)
> Pct. diabetic: 7.6% (6th lowest)
> Poverty rate: 16.5% (19th highest)

Montana’s median household income of $46,972 was lower than the national figure, the only state with a low obesity rate to have a lower median household income than the national figure of $52,250. Other factors such as strong educational attainment rates likely contributed to the low obesity rate. Nearly 93% of adults had completed at least high school, the third-highest rate nationwide. Such high educational attainment may have helped raise health literacy among the state’s population, which may have helped lower the chances of unhealthy weight gain. The incidence of diabetes — a disease linked to high levels of obesity — was the lowest in the nation, with diagnosed cases in just 6.2% of the population.

5. California
> Obesity rate: 24.1%
> Pct. physically inactive: 16.8% (4th lowest)
> Pct. diabetic: 8.1% (8th lowest)
> Poverty rate: 16.8% (16th highest)

California’s population makes, on average, healthier choices than the nation as a whole, a fact that likely has helped the state maintain one of the lowest obesity rates in the country. Just 16.5% of the state’s adults failed to eat at least one vegetable per day, and only 30.4% ate less than one fruit per day, both rates were second-lowest in the nation. Barely one in six adults reported being physically inactive recently, fewer than in all but a handful of states. Higher education attainment rates have been shown to be related to healthier lifestyles and lower obesity. California, however, had the worst rate of adults with at least a high school degree in the country. Nearly one out of every five adults lacked this degree, compared to 13.7% nationwide.

4. Utah
> Obesity rate: 24.1%
> Pct. physically inactive: 16.6% (3rd lowest)
> Pct. diabetic: 7.0% (3rd lowest)
> Poverty rate: 12.7% (15th lowest)

High blood pressure and cholesterol are strongly associated with obesity. In Utah, which had the nation’s fourth lowest obesity rate, just over 24% of residents reported high blood pressure, and just over 33% reported high cholesterol, both the lowest rates nationwide. Frequent exercise among Utah residents likely helped lower the incidence of obesity and its associated health conditions. Less than 17% did not participate in any physical activity in the past 30 days, nearly the lowest percentage in the country.

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3. Massachusetts
> Obesity rate: 23.6%
> Pct. physically inactive: 21.4% (16th lowest)
> Pct. diabetic: 8.9% (22nd lowest)
> Poverty rate: 11.9% (11th lowest)

Childhood obesity appears to be slightly more of a problem in Massachusetts. While the state had the third lowest obesity rate among adults, it had only the 13th lowest obesity rate among students in grades 9-12. More than 40% of the state’s adults had a bachelor’s degree or higher, the highest in the nation and more than 10 percentage points above the national rate. Massachusetts’ median income of $66,768 was sixth highest in the country. The relatively wealthier state population was able to afford healthier food and exercise options, and their education likely helped them make healthier choices. Massachusetts’ fruit and vegetable intake and exercise rates among adults were all better than the national measures.

2. Hawaii
> Obesity rate: 21.8%
> Pct. physically inactive: 18.2% (6th lowest)
> Pct. diabetic: 8.3% (10th lowest)
> Poverty rate: 10.8% (5th lowest)

Even with the exceptionally high cost of living in Hawaii, residents were wealthy compared to most Americans. The median household income of $68,020 was the fourth highest nationwide. High incomes likely helped residents live healthier lifestyles. In addition, Hawaii residents may find more exercise opportunities than in other U.S. regions, as outdoor sports and other activities can be done nearly year-round. The average temperature is a comfortable 75 degrees Fahrenheit. Just over 18% of residents reported physical inactivity in the past 30 days, one of the lowest proportions in the country. The low obesity rate accompanied a relatively low prevalence of several other poor health outcomes. There were 139 heart disease-related deaths per 100,000 people, for example, nearly the lowest such rate in the country.

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1. Colorado
> Obesity rate: 21.3%
> Pct. physically inactive: 15.2% (the lowest)
> Pct. diabetic: 6.2% (the lowest)
> Poverty rate: 13.0% (16th lowest)

Colorado’s obesity rate of 21.3% was the lowest of all states and considerably lower than the national rate. Frequent exercise may have helped keep the state’s residents in shape. Just 15.2% did not participate in any physical exercise in the past 30 days, the lowest percentage in the nation. Residents also had relatively healthy diets. Less than one in five Colorado residents reported less-than-daily vegetable consumption, one of the lowest shares compared to other states. As a result of the healthy habits, and in turn, the low obesity rate, the state had extremely low rates of the diseases commonly associated with obesity. Colorado was ranked in the bottom three for cardiovascular deaths per 100,000, cancer deaths per 100,000, high cholesterol, and high blood pressure.

Click here to see the states with the highest obesity rates.

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