The United States is infamous for its obesity problem, and with good cause. The national obesity rate across the country spiked from 23% to 35% between the late 1980s and the early 2000s. There are a multitude of social and economic factors that predispose certain populations to obesity. High obesity rates can in return detrimentally affect the health and life expectancy of the population.

While the country is facing an obesity crisis, the problem is much more pronounced in certain areas. Obesity rates in each state’s most obese county range from 46.6% in Holmes, Mississippi, to 23.8% in Kalawao County, Hawaii. To identify the most obese county in each state, 24/7 Wall St. reviewed county-level health data from County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program.

In an interview with 24/7 Wall St., Julie Willems Van Dijk, co-director of the County Health Rankings and Roadmaps program at the University of Wisconsin, explained that high obesity rates in the United States can explained that high obesity rates in the United States are due to “a complex interaction of genetics, behavior, and environment.”

Click here to see the most obese counties in each state

Data indeed show that certain environmental conditions and financial circumstances can drastically affect obesity rates in a given population. For example, low income areas are often more likely to have a relatively large share of obese adults, as financial instability can greatly limit healthy food options. “Processed foods or fast foods are generally less expensive than fresh fruits and vegetables or meat,” Willems Van Dijk said. “The affordability of calorie-dense, low-nutrition foods is definitely a factor.” According to the data, the typical household in 39 of these 50 counties earns less than the national median income of $53,700.

A number of these counties are rural. In such areas, the nearest grocery store with healthy food options may be far away. “If you’re fairly low income and the nearest grocery store is five or 10 miles away and you don’t have a car or you don’t have money to put gas in the car you have,” Willems Van Dijk explained.

Sedentary lifestyles are a major causal factor of obesity, Willems Van Dijk further explained. Consequently, obesity rates are often high in areas with limited access to places where residents can be physically active. In 44 of the 50 counties examined, residents have less access to areas for physical activity, such as parks or recreation centers, than the rest of the state. In Menominee County, Wisconsin for example, only 7.4% of residents have access to areas for physical activity. Meanwhile, 81.7% of Wisconsin residents have access to such areas. Perhaps not surprisingly, 41.0% of Menominee County adults are obese, while only 29.4% of Wisconsin adults are obese.

While the underlying causes of obesity are complex, obesity’s effects on the quality and length of life are much clearer. “Obesity leads to so many chronic diseases,” Willems Van Dijk explained that it “predisposes people to early deaths in many ways.” Obesity is linked to diabetes, heart attack, stroke, and high blood pressure. Preventable death before age 75 is more common than it is across the corresponding state in 41 of the the 50 counties examined.

Not only are adults in obese areas more likely to lead shorter lives, but also their lives are far more likely to be difficult. In addition to increased susceptibility to certain chronic diseases, obesity also “brings a myriad of quality of life issues,” Willems Van Dijk said. In 41 of these 50 counties, a larger share of adults report being in fair or poor health than the corresponding statewide share.

To identify the most obese county in every state, 24/7 Wall St. reviewed county-level data from County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program. We also considered individual measures of health outcomes and health factors. The health factors component included measures of healthy behavior, clinical care, social and economic factors, and physical environment measures. Data were compiled from over 20 different sources and are as of the most recent year available. A total of 3,140 counties were considered.

These are the most obese counties in each state.

1. Alabama
> Most obese county: Lowndes
> County obesity rate: 46.4%
> Statewide obesity rate: 33.6%
> Pct. of adults who exercise regularly: 69.2%
> Share of adults reporting fair or poor health: 31.5%

Lowndes is not only the most obese county in Alabama, but also nearly the most obese county in the United States. The county’s obesity rate of 46.4% is higher than Alabama’s overall obesity rate of 33.6% and much higher than the national obesity rate of 27.0%. Just 1.5% of Lowndes residents have access to recreational opportunities, an extremely small proportion compared with the 62.8% of state residents with access to exercise opportunities, itself one of lowest levels of access compared with other states.

2. Alaska
> Most obese county: Aleutians West
> County obesity rate: 36.2%
> Statewide obesity rate: 28.4%
> Pct. of adults who exercise regularly: 76.1%
> Share of adults reporting fair or poor health: 14.0%

Roughly 36% of adults in the Aleutians West area are obese, nearly 8 percentage points greater than Alaska’s obesity rate. In Aleutians West, the high obesity rate is accompanied by a relatively low exercise rate. Only about 76% of area adults report regular physical activity, a smaller share than the approximately 80% of adults statewide who get regular exercise.

3. Arizona
> Most obese county: Greenlee
> County obesity rate: 33.4%
> Statewide obesity rate: 23.5%
> Pct. of adults who exercise regularly: 75.8%
> Share of adults reporting fair or poor health: 19.6%

Only 23.5% of Arizona adults are obese, a smaller rate than the national obesity rate of 27%. Not all parts of the state, however, have such a healthy population. In Greenlee, one in every three adults are obese, a larger share than in every other county in the state.

4. Arkansas
> Most obese county: Phillips
> County obesity rate: 41.5%
> Statewide obesity rate: 33.3%
> Pct. of adults who exercise regularly: 62.0%
> Share of adults reporting fair or poor health: 32.1%

Just 62.0% of of Phillips County adults exercise regularly, a smaller share than the 68.5% of those statewide who exercise and a much smaller share than the 77.0% of adults who exercise nationwide. This is one factor that may contribute to Phillips County’s 41.5% adult obesity rate, the highest in Arkansas and among the highest in the United States.

5. California
> Most obese county: Stanislaus
> County obesity rate: 32.4%
> Statewide obesity rate: 22.5%
> Pct. of adults who exercise regularly: 81.7%
> Share of adults reporting fair or poor health: 20.2%

Nearly one in three adults in Stanislaus County are obese, the largest such share in California. Obesity can lead to a host of negative health outcomes. In Stanislaus, 20% of county adults report being in fair or poor health, compared to only 17% of Californians.

6. Colorado
> Most obese county: Morgan
> County obesity rate: 27.8%
> Statewide obesity rate: 20.1%
> Pct. of adults who exercise regularly: 79.7%
> Share of adults reporting fair or poor health: 14.3%

Colorado’s statewide obesity rate of 20.1% is the lowest of all states. Even Morgan County’s obesity rate of 27.8%, while the highest in the state, is only slightly worse than the 27.0% national obesity rate. County residents also suffer from worse health outcomes than statewide residents. In Morgan, 6,959 years of potential life are lost per 100,000 residents annually due to premature death, higher than the statewide premature death rate of 5,731 years lost per 100,000 Colorado residents.

7. Connecticut
> Most obese county: Windham
> County obesity rate: 28.9%
> Statewide obesity rate: 24.7%
> Pct. of adults who exercise regularly: 76.0%
> Share of adults reporting fair or poor health: 12.3%

A relatively healthy state, Connecticut’s obesity rate is roughly 2 percentage points lower than the 27% national rate. Unlike most states, residents of Connecticut’s most obese county are only slightly more obese than adults across the nation. Windham County’s obesity rate is only about 2 percentage points higher than the national rate.

8. Delaware
> Most obese county: Kent
> County obesity rate: 33.2%
> Statewide obesity rate: 29.0%
> Pct. of adults who exercise regularly: 71.9%
> Share of adults reporting fair or poor health: 15.7%

Kent County’s 33.2% obesity rate is the highest of any county in Delaware. County residents report other relatively unhealthy behaviors. The county’s smoking rate of 18.2% is the highest in Delaware. Also, 71.9% of adults report exercising regularly, the smallest such share of state counties.

9. Florida
> Most obese county: Calhoun
> County obesity rate: 40.7%
> Statewide obesity rate: 25.5%
> Pct. of adults who exercise regularly: 66.1%
> Share of adults reporting fair or poor health: 18.8%

Calhoun is not only the most obese county in Florida, but it is also one of the most obese counties in the United States. Roughly 41% of adults in Calhoun are obese, much higher than the 25.5% statewide obesity rate and the 27.0% national rate. Obesity can have a detrimental impact on a range of other health outcomes. County results report experiencing more physically and mentally unhealthy days a month than Floridians and Americans do on average.

10. Georgia
> Most obese county: Clayton
> County obesity rate: 39.5%
> Statewide obesity rate: 29.0%
> Pct. of adults who exercise regularly: 74.0%
> Share of adults reporting fair or poor health: 20.7%

In Clayton, Georgia’s most obese county, residents are more likely to report other signs of poor health than state residents, on average. County adults report an average of 4.3 physically unhealthy days and 4.2 mentally unhealthy days per month, considerably more than the 3.8 physically unhealthy days and 3.8 mentally unhealthy days the typical Georgian reports monthly.

11. Hawaii
> Most obese county: Kalawao
> County obesity rate: 23.8%
> Statewide obesity rate: 22.1%
> Pct. of adults who exercise regularly: 76.9%
> Share of adults reporting fair or poor health: 16.3%

With a 22.1% obesity rate, Hawaii is one of the most healthy states in the country. So while Kalawao County’s 23.8% obesity rate is the highest in the state, it is still lower than the 27.0% national obesity rate. County residents also report worse health outcomes than state residents, with 16.3% of county adults reporting fair to poor health compared to 13.2% of Hawaiian adults.

12. Idaho
> Most obese county: Oneida
> County obesity rate: 35.9%
> Statewide obesity rate: 27.7%
> Pct. of adults who exercise regularly: 81.0%
> Share of adults reporting fair or poor health: 13.0%

Oneida County’s obesity rate of 35.9% is far higher than Idaho’s obesity rate of 27.7% and higher than any other county in the state. Unlike the most obese counties in most other states, Oneida County’s health outcomes are somewhat in line with Idaho as a whole. Both county and statewide adults report feeling physically unwell 3.6 days and mentally unwell for 3.5 days every month on average.

13. Illinois
> Most obese county: Vermilion
> County obesity rate: 37.3%
> Statewide obesity rate: 27.4%
> Pct. of adults who exercise regularly: 73.4%
> Share of adults reporting fair or poor health: 16.2%

While the obesity rate across Illinois is roughly in line with the national rate, obesity is a much bigger problem in Vermilion County. More than 37% of Vermilion adults are obese, the largest share of any county in the state. Since the least healthy food is often the least expensive, a high level of food insecurity can contribute to a high obesity rate. In Vermilion, 17.1% of people are food insecure, higher than the state and national percentages.

14. Indiana
> Most obese county: Jackson
> County obesity rate: 39.3%
> Statewide obesity rate: 31.4%
> Pct. of adults who exercise regularly: 70.0%
> Share of adults reporting fair or poor health: 16.4%

An especially high 39.3% obesity rate in Jackson County may partially explain the higher than average premature death rate in the county. Every year, 8,744 years of life are lost before age 75 due to preventable causes per 100,000 Jackson residents, considerably more than the corresponding statewide rate of 7,611 years of potential life lost.

15. Iowa
> Most obese county: Fayette
> County obesity rate: 38.5%
> Statewide obesity rate: 30.7%
> Pct. of adults who exercise regularly: 70.6%
> Share of adults reporting fair or poor health: 11.9%

Fayette County’s 38.5% obesity rate is the highest of any Iowa county. Unlike the most obese counties in most other states, however, county adults report some healthier behaviors and outcomes than statewide residents. The 16.7% smoking rate and 19.2% excessive drinking rate in the county are both lower than their corresponding state rates. Also, a smaller share of adults in Fayette County report being in fair or poor health than across the state Iowa.

16. Kansas
> Most obese county: Cherokee
> County obesity rate: 38.7%
> Statewide obesity rate: 30.2%
> Pct. of adults who exercise regularly: 67.3%
> Share of adults reporting fair or poor health: 16.2%

Nearly 39% of adults in Cherokee County are obese, a far greater share than the 30% statewide obesity rate. A higher than average obesity rate in the county may be partially attributable to a lower than average exercise rate. Only 67% of adults in Cherokee report regular physical activity compared to 75% of adults statewide who exercise regularly.

17. Kentucky
> Most obese county: Breathitt
> County obesity rate: 42.9%
> Statewide obesity rate: 32.3%
> Pct. of adults who exercise regularly: 66.8%
> Share of adults reporting fair or poor health: 28.4%

Only a handful of U.S. counties have a higher obesity rate than Breathitt, where nearly 43% of adults are obese. Kentucky itself is not an especially healthy state. Nearly one in three adults in Kentucky are obese, the seventh highest obesity rate of any state in the country.

18. Louisiana
> Most obese county: East Carroll
> County obesity rate: 43.2%
> Statewide obesity rate: 34.3%
> Pct. of adults who exercise regularly: 63.4%
> Share of adults reporting fair or poor health: 37.9%

The most obese county in a fairly unhealthy state, East Carroll Parish’s 43.2% obesity rate is the highest in Louisiana and among the highest in the United States. East Carroll Parish residents also report some of the worst health outcomes in the state and nation. Almost 38% of adults report feeling in fair or poor health, higher than the 20.8% of Alabama adults who report such poor health and the fifth largest share of any U.S. county.

19. Maine
> Most obese county: Aroostook
> County obesity rate: 33.9%
> Statewide obesity rate: 27.9%
> Pct. of adults who exercise regularly: 72.3%
> Share of adults reporting fair or poor health: 15.7%

Aroostook County’s 33.9% obesity rate is higher than both Maine’s 27.9% obesity rate and the 27.0% national obesity rate. Perhaps as a result, county residents have relatively poor health outcomes. For every 100,000 county residents, 7,503 years of potential life are lost annually due to premature death. To compare, 6,314 years of potential life are lost per 100,000 Maine residents annually due to premature death.

20. Maryland
> Most obese county: Somerset
> County obesity rate: 39.5%
> Statewide obesity rate: 28.4%
> Pct. of adults who exercise regularly: 68.9%
> Share of adults reporting fair or poor health: 20.1%

Nearly two in five Somerset County adults are obese, the highest obesity rate in Maryland and among the highest rates in the United States. County adults also report worse health outcomes than statewide adults. More than 20% of Somerset County adults report being in fair or poor health, compared to 13% in Maryland as a whole and 14% nationwide.

21. Massachusetts
> Most obese county: Hampden
> County obesity rate: 28.5%
> Statewide obesity rate: 23.7%
> Pct. of adults who exercise regularly: 73.9%
> Share of adults reporting fair or poor health: 18.9%

Massachusetts is an especially healthy state and the obesity rate in Hampden County is only slightly higher than the national obesity rate of 27%. Despite being the most obese county in Massachusetts, Hampden’s 28.5% obesity rate is lower than the obesity rate in nearly half of all states. Strong health insurance coverage rates across the state and in Hampden may help encourage more frequent doctor visits and contribute to the lower obesity rate. Just 5% of adults in the area do not have insurance, one of the lowest proportions nationwide.

22. Michigan
> Most obese county: Saginaw
> County obesity rate: 39.7%
> Statewide obesity rate: 31.4%
> Pct. of adults who exercise regularly: 76.1%
> Share of adults reporting fair or poor health: 14.9%

Saginaw County’s 39.7% obesity rate is the highest of any Michigan county and among the highest in the United States. Obesity can lead to a variety of other health issues and ultimately lead to a shorter life expectancy. For every 100,000 Saginaw County residents, 8,125 years of potential life are lost to premature death annually, a higher incidence than the 7,218 years of potential life lost per 100,000 Michigan residents and the 6,600 years of potential life lost per 100,000 Americans due to premature death before the age of 75.

23. Minnesota
> Most obese county: McLeod
> County obesity rate: 33.6%
> Statewide obesity rate: 26.3%
> Pct. of adults who exercise regularly: 79.0%
> Share of adults reporting fair or poor health: 10.2%

McLeod County’s 33.6% obesity rate is the highest in Minnesota. Unlike most places struggling with obesity, county residents report some of the best health outcomes compared to both the rest of the state and the country. The average resident reports feeling physically and mentally unwell for just 2.4 and 2.6 days per month, respectively, less time than the average Minnesota resident and about a full day less of feeling unwell than the average American.

24. Mississippi
> Most obese county: Holmes
> County obesity rate: 46.6%
> Statewide obesity rate: 35.3%
> Pct. of adults who exercise regularly: 62.4%
> Share of adults reporting fair or poor health: 35.6%

With a 47% obesity rate, Holmes is not only the most obese county in Mississippi, but also the most obese county in the United States. Obesity can lead to a number of deadly diseases, and premature death is far more common in Holmes County than it is across the country. Each year, 13,613 years of life are lost before age 75 per 100,000 county residents, more than double the corresponding national rate of 6,600 years of potential life lost per 100,000 Americans.

25. Missouri
> Most obese county: Caldwell
> County obesity rate: 39.2%
> Statewide obesity rate: 30.6%
> Pct. of adults who exercise regularly: 68.0%
> Share of adults reporting fair or poor health: 16.0%

The 39.2% obesity rate in the entirely rural Caldwell County is far higher than both the 30.6% statewide obesity rate and the 27.0% national obesity rate. Often, a rural environment can limit access to healthy food and opportunities for exercise. While the 8.0% of county residents have limited access to healthy food, not much worse than the 6.2% statewide figure, just 33.7% of county residents have access to exercise venues — less than half the 76.3% statewide share of Missouri residents with such access.

26. Montana
> Most obese county: Big Horn
> County obesity rate: 36.7%
> Statewide obesity rate: 24.6%
> Pct. of adults who exercise regularly: 70.8%
> Share of adults reporting fair or poor health: 22.3%

While Montana’s 25% obesity rate is roughly 2 percentage points lower than the national obesity rate, Big Horn County’s obesity rate of nearly 37% exceeds the national rate by roughly 10 percentage points. As in many counties with high obesity rates, diabetes is relatively common in Big Horn. Roughly 13% of county adults have diabetes compared to a statewide diabetes rate of just under 9%. Big Horn County contains parts of both Crow and Northern Cheyenne American Indian reservations, and 64.4% of the population is American Indian, a population that tends to struggle with obesity.

27. Nebraska
> Most obese county: Thurston
> County obesity rate: 40.8%
> Statewide obesity rate: 29.5%
> Pct. of adults who exercise regularly: 69.6%
> Share of adults reporting fair or poor health: 22.9%

More than two in five Thurston County adults are obese, the highest obesity rate of Nebraska counties and one of the highest in the United States. Obesity is linked to many adverse health outcomes and can lead to a shorter life expectancy. For every 100,000 residents in Thurston County, 13,034 years of potential life are lost to premature death annually. This is more than twice the incidence of premature death per capita in Nebraska, where 5,815 years of life per 100,000 residents are lost prematurely each year.

28. Nevada
> Most obese county: Pershing
> County obesity rate: 32.4%
> Statewide obesity rate: 25.4%
> Pct. of adults who exercise regularly: 76.9%
> Share of adults reporting fair or poor health: 19.0%

Pershing County’s entirely rural environment may contribute to its 32.4% obesity rate, the highest in Nevada. Just 22.6% of county residents have access to places for physical activity, about one-fourth the corresponding statewide share. While obese individuals are at greater risk of adverse health outcomes that can eventually lead to an untimely death, Pershing County actually has a lower incidence of premature death than Nevada as a whole. For every 100,000 county residents, 5,877 years of potential life are lost annually to premature death, much less than the 7,036 years of potential life lost per 100,000 Nevada residents.

29. New Hampshire
> Most obese county: Belknap
> County obesity rate: 30.7%
> Statewide obesity rate: 27.3%
> Pct. of adults who exercise regularly: 77.7%
> Share of adults reporting fair or poor health: 11.9%

Apart from its high obesity rate, Belknap County is in line with the New Hampshire by many measures of health. In both the county and the state, about 12% of adults report feeling in fair or poor health. Similarly, residents of both the county and the state report feeling physically unwell for about three days a month and mentally unwell for 3.4 days.

30. New Jersey
> Most obese county: Cumberland
> County obesity rate: 33.6%
> Statewide obesity rate: 24.7%
> Pct. of adults who exercise regularly: 72.3%
> Share of adults reporting fair or poor health: 21.1%

Cumberland County’s 33.6% obesity rate is much higher than New Jersey’s 24.7% obesity rate. Obesity is associated with a number of adverse health issues, such as cardiovascular disease, stroke, and diabetes, and can ultimately lead to shorter life spans. For every 100,000 Cumberland residents, close to 8,000 years are lost due to preventable untimely deaths. The rate is much higher than the incidence of premature death across the state.

31. New Mexico
> Most obese county: Lea
> County obesity rate: 34.7%
> Statewide obesity rate: 23.6%
> Pct. of adults who exercise regularly: 67.0%
> Share of adults reporting fair or poor health: 18.9%

Lea County’s 34.7% obesity rate is far higher than both New Mexico’s 23.6% obesity rate and the nation’s 27.0% obesity rate. While recent research has suggested diet to be more important to weight management than exercise, physical activity is still a major insight into the health of a population. In Lea County, just 67% of adults exercise regularly, the smallest share of any Nevada county.

32. New York
> Most obese county: Chenango
> County obesity rate: 32.8%
> Statewide obesity rate: 24.1%
> Pct. of adults who exercise regularly: 72.8%
> Share of adults reporting fair or poor health: 13.1%

Apart from a high obesity rate, Chenango County is somewhat in line with the rest of New York by many measures of health and wellness. In both the county and statewide, 15.2% of adults smoke and 17.6% drink excessively, each measure slightly below the corresponding national figure. However, the incidence of premature death is higher in the county than it is in the state. Each year an estimated 6,474 years are lost per 100,000 people to preventable causes compared to 5,408 years of life lost per 100,000 New Yorkers.

33. North Carolina
> Most obese county: Halifax
> County obesity rate: 39.4%
> Statewide obesity rate: 29.1%
> Pct. of adults who exercise regularly: 65.2%
> Share of adults reporting fair or poor health: 23.6%

Poor access to food in Halifax County and poor behaviors among residents may partially explain the area’s high prevalence of obesity. More than 25% of county residents lack a reliable source of healthy food, a much larger share than the 18% of food insecure North Carolinians. Similarly, just 65.2% of Halifax adults exercise regularly, the smallest share of any North Carolina county.

34. North Dakota
> Most obese county: Rolette
> County obesity rate: 41.1%
> Statewide obesity rate: 30.2%
> Pct. of adults who exercise regularly: 65.9%
> Share of adults reporting fair or poor health: 29.0%

Rolette County is the home of the Turtle Mountain Reservation and its population is more than three-fourths American Indian. Indian reservations often face difficult economic and health problems, and high obesity is one of many health issues in Rolette County. A whopping 37.5% of county adults smoke, the fifth highest smoking rate of any U.S. county. Also, 17.6% of residents lack a reliable source of healthy food — the highest such share in North Dakota.

35. Ohio
> Most obese county: Lawrence
> County obesity rate: 38.9%
> Statewide obesity rate: 30.5%
> Pct. of adults who exercise regularly: 62.7%
> Share of adults reporting fair or poor health: 18.3%

Although Lawrence County residents have the most access to recreational opportunities of any Ohio county, also exercise the least. Just 62.7% of county adults exercise regularly, a much smaller share than the 73.7% of Ohio adults statewide who do. Lawrence County also has higher shares of adults with diabetes and adults who feel mentally and physically unwell than in Ohio.

36. Oklahoma
> Most obese county: Washita
> County obesity rate: 41.4%
> Statewide obesity rate: 32.4%
> Pct. of adults who exercise regularly: 66.2%
> Share of adults reporting fair or poor health: 15.7%

Washita County’s rural layout may limit access to healthy food and recreational opportunities, ultimately contributing to worse health outcomes. Just 44.1% of county residents have access to places for physical activity compared to 69.3% of residents statewide. Similarly, 16.0% of residents are low income and live relatively far from a grocery store compared to the 8.9% of Oklahoma residents statewide with limited food access.

37. Oregon
> Most obese county: Polk
> County obesity rate: 34.0%
> Statewide obesity rate: 26.0%
> Pct. of adults who exercise regularly: 82.3%
> Share of adults reporting fair or poor health: 13.7%

Polk County’s 34% obesity rate is higher than both Oregon’s 26% obesity rate and the nation’s 27% obesity rate. Unlike most counties with the highest obesity rates, Polk is about as healthy as Oregon overall by many other measures of health and wellness. The premature death rate in the county is lower than both the state and national figures.

38. Pennsylvania
> Most obese county: Fayette
> County obesity rate: 36.2%
> Statewide obesity rate: 28.8%
> Pct. of adults who exercise regularly: 66.0%
> Share of adults reporting fair or poor health: 17.9%

No Pennsylvania county has a higher share of obese adults than Fayette County. County residents also report other relatively unhealthy behaviors. Only 66% of county adults regularly exercise, a smaller share than the 74% of adults statewide who do. Similarly, the 22.5% smoking rate in Fayette County is higher than Pennsylvania’s 18.9% smoking rate, which itself is higher than the national smoking rate of 17%.

39. Rhode Island
> Most obese county: Kent
> County obesity rate: 27.7%
> Statewide obesity rate: 26.4%
> Pct. of adults who exercise regularly: 77.3%
> Share of adults reporting fair or poor health: 11.8%

Rhode Island is a fairly healthy state. So while Kent County’s 27.7% obesity rate is the highest of any Rhode Island county, it is only slightly higher than the 27.0% national rate. By other measures, Kent County is actually healthier than both the state and the country. Of county adults, 8.8% have diabetes, 14.9% smoke, and 11.8% report fair or poor health — all smaller than the corresponding state and national shares.

40. South Carolina
> Most obese county: Lee
> County obesity rate: 43.9%
> Statewide obesity rate: 31.6%
> Pct. of adults who exercise regularly: 69.3%
> Share of adults reporting fair or poor health: 26.0%

South Carolina is one of the least healthy states. Not only is Lee County’s 43.9% obesity rate the highest in the state, but it is also the ninth highest of any U.S. county. Relatively low incomes in Lee County may prevent residents from maintaining a healthy diet, the most important aspect in weight management. About 22% of country residents lack a reliable source of healthy food, a higher share than the 17% of South Carolinians who do.

41. South Dakota
> Most obese county: Oglala Lakota
> County obesity rate: 44.5%
> Statewide obesity rate: 29.8%
> Pct. of adults who exercise regularly: 76.2%
> Share of adults reporting fair or poor health: 32.5%

Oglala Lakota County is entirely within the Pine Ridge Indian Reservation, an area plagued by extreme poverty, high infant mortality, and suicide. The Oglala Sioux tribe struggles not just with obesity — the county’s 44.5% obesity rate is the fifth highest of all U.S. counties — but with many other severe health issues as well. The incidence of premature death in Oglala Lakota County, estimated at 23,876 years lost per 100,000 people, is the second highest of all U.S. counties.

42. Tennessee
> Most obese county: Haywood
> County obesity rate: 41.3%
> Statewide obesity rate: 32.2%
> Pct. of adults who exercise regularly: 62.1%
> Share of adults reporting fair or poor health: 29.8%

Inadequate exercise may be one factor impacting the health of Haywood County. Just 16.4% of Haywood County residents have access to recreational opportunities compared to 69.3% of Tennessee residents who do. Similarly, 62.1% of adults exercise regularly, a smaller share than the 67.8% of Tennessee adults who do — itself the second lowest activity rate of any state in the nation.

43. Texas
> Most obese county: Jefferson
> County obesity rate: 36.9%
> Statewide obesity rate: 28.4%
> Pct. of adults who exercise regularly: 70.0%
> Share of adults reporting fair or poor health: 19.5%

Insufficient diet and exercise may be contributing to Jefferson County’s high obesity rate. Across the county, 24.9% of residents lack a reliable source of healthy food, a much higher share than the 17.6% of food insecure Texans. Similarly, 70.0% of county adults exercise regularly, a smaller share than the corresponding 75.9% state activity rate.

44. Utah
> Most obese county: Box Elder
> County obesity rate: 32.8%
> Statewide obesity rate: 24.9%
> Pct. of adults who exercise regularly: 79.4%
> Share of adults reporting fair or poor health: 12.8%

Despite Box Elder County’s 32.8% obesity rate, the highest in the state, county residents report relatively healthy behaviors. The county has one of the most concentrated Mormon populations in Utah, a religion that largely forbids drinking and smoking. Perhaps as a result, the county’s 9.2% smoking and 11.0% excessive drinking rates are lower than the corresponding state rates and among the lowest in the country.

45. Vermont
> Most obese county: Orleans
> County obesity rate: 29.9%
> Statewide obesity rate: 24.4%
> Pct. of adults who exercise regularly: 75.2%
> Share of adults reporting fair or poor health: 11.7%

Nearly 30% of Orleans County adults are obese, the largest share of any Vermont county. Obesity can increase the risk of cardiac arrest, stroke, and diabetes, among other diseases, and ultimately lead to premature death. For every 100,000 county residents, 7,059 years of potential life are lost to premature death annually — about 1,500 more years of life lost than the corresponding state figure and the highest incidence of premature death in Vermont.

46. Virginia
> Most obese county: Sussex
> County obesity rate: 38.7%
> Statewide obesity rate: 27.3%
> Pct. of adults who exercise regularly: 72.7%
> Share of adults reporting fair or poor health: 22.4%

In some parts of the country, a rural environment can limit access to healthy food and opportunities for exercise and ultimately lead to less healthy behaviors. In rural Sussex County, just 3.3% of residents have access to recreational opportunities compared to 80.7% of Virginia residents overall. Similarly, 12.2% of county residents are low income and live relatively far from a grocery store, a much larger share than the 3.7% of Virginians in a similar position.

47. Washington
> Most obese county: Grays Harbor
> County obesity rate: 36.5%
> Statewide obesity rate: 27.2%
> Pct. of adults who exercise regularly: 72.4%
> Share of adults reporting fair or poor health: 16.3%

In Grays Harbor County, 36.5% of adults are obese, a larger share than any other county in Washington. Obesity can increase the incidence of heart disease, stroke, and diabetes, among other health issues, and ultimately lead to premature death. In Grays Harbor County, 8,375 years are lost per 100,000 people annually, well above the state and national estimates.

48. West Virginia
> Most obese county: Logan
> County obesity rate: 41.2%
> Statewide obesity rate: 34.1%
> Pct. of adults who exercise regularly: 63.1%
> Share of adults reporting fair or poor health: 25.8%

In Logan, more than 41% of adults are obese, the largest share of any county in West Virginia and one of the largest of U.S. counties. Obesity can lead to several chronic conditions that can dramatically decrease life expectancy. For every 100,000 county resident, 15,345 years of potential life are lost each year due to premature death before age 75, considerably more than the 9,731 years of life lost statewide.

49. Wisconsin
> Most obese county: Menominee
> County obesity rate: 41.0%
> Statewide obesity rate: 29.4%
> Pct. of adults who exercise regularly: 69.5%
> Share of adults reporting fair or poor health: 28.2%

Menominee County is home to the Menominee Indian Reservation and its population is 82.2% American Indian. Indian reservations tend to be some of the least healthy places in the country, and Menominee County struggles with many health issues in addition to obesity. On average, county adults feel physically unwell 5.8 days a month and mentally unwell for 5.3 days a month, the most of any Wisconsin county and among the most nationwide.

50. Wyoming
> Most obese county: Campbell
> County obesity rate: 33.6%
> Statewide obesity rate: 26.6%
> Pct. of adults who exercise regularly: 74.6%
> Share of adults reporting fair or poor health: 12.8%

More than one in three Campbell County adults are obese, the highest obesity rate in Wyoming. County residents report other relatively unhealthy behaviors, with higher smoking, drinking, and inactivity rates than those of Wyoming residents overall. Despite this, county residents have slightly better health outcomes than residents statewide. For every 100,000 county residents, 6,914 years of potential life are lost due to premature death annually, slightly less than the corresponding statewide figure of 7,194 years of life lost.

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