The average life expectancy of moderately obese people is about three years shorter than it is for the average American. At the extreme, severe obesity can lower life expectancy by 10 years. Approximately 36.5% of American adults are obese. Only smoking causes more premature death than obesity in the United States.

The prevalence of obesity varies dramatically throughout the country. Western and Northeastern states tend to have lower rates of obesity, while in Southern states obesity is highest. Even within states, obesity rates are far from uniform.

Within Virginia, for example, rates vary from 16.1% in Arlington County to 41.4% in Petersburg City, a county equivalent. This is the widest difference of any state. Using data from the Centers for Disease Control and Prevention, 24/7 Wall St. identified the most obese county in every state.

Click here to see the most obese county in every state.

Obesity is most commonly measured using a ratio between a person’s weight and height called the body mass index, or BMI. A BMI equal to or greater than 30 is considered obese. The most obese county in America is Claiborne County, Mississippi, where 47.6% of adults are obese.

Diet and exercise are well-established as the most important factors in maintaining a healthy weight. A healthy diet rich in fruits and vegetables tends to cost more than an unhealthy diet consisting of processed foods and refined grains. Areas with high poverty rates tend to have a smaller share of residents that have access to areas of exercise such as parks or fitness centers, and low-income individuals are less likely to be able to afford a gym membership.

In 43 states, the county with the largest share of obese adults has a higher poverty rate than the state as a whole.

Because of obesity, the counties on this list have a higher prevalence of many health conditions, including heart disease, stroke, some cancers, and type 2 diabetes. In 1993, roughly 3% of Americans had diabetes. As obesity rates increased, diabetes prevalence more than doubled over the next 20 years.

In 45 of the 50 counties the incidence of diabetes is higher than the statewide rate. In Alabama’s most obese county, more than 20% of residents have diabetes. This compares to the statewide incidence of 13.8%, itself well above the 7.0% of people nationwide with the condition.

To determine the most obese county in every state, 24/7 Wall St reviewed 2013 county-level obesity rates from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System. Statewide obesity rates, physical activity rates, and diabetes prevalence for the same year also come from the CDC.

This is the most obese county in every state.

1. Alabama
> Most obese county: Greene County
> County obesity rate: 46.3%
> Statewide obesity rate: 32.4% (8th highest)
> Adults who do not exercise: 31.7%
> Adults with diabetes: 21.0%

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2. Alaska
> Most obese county: Bristol Bay Borough
> County obesity rate: 39.7%
> Statewide obesity rate: 28.4% (23rd lowest)
> Adults who do not exercise: 21.2%
> Adults with diabetes: 8.5%

3. Arizona
> Most obese county: Apache County
> County obesity rate: 35.2%
> Statewide obesity rate: 26.8% (17th lowest)
> Adults who do not exercise: 21.4%
> Adults with diabetes: 14.4%

4. Arkansas
> Most obese county: Phillips County
> County obesity rate: 45.5%
> Statewide obesity rate: 34.6% (3rd highest)
> Adults who do not exercise: 35.9%
> Adults with diabetes: 16.7%

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5. California
> Most obese county: Stanislaus County
> County obesity rate: 32.6%
> Statewide obesity rate: 24.1% (tied-4th lowest)
> Adults who do not exercise: 20.0%
> Adults with diabetes: 9.7%

6. Colorado
> Most obese county: Kit Carson County
> County obesity rate: 27.6%
> Statewide obesity rate: 21.3% (the lowest)
> Adults who do not exercise: 24.5%
> Adults with diabetes: 7.3%

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7. Connecticut
> Most obese county: Windham County
> County obesity rate: 29.6%
> Statewide obesity rate: 25.0% (8th lowest)
> Adults who do not exercise: 24.5%
> Adults with diabetes: 10.1%

8. Delaware
> Most obese county: Kent County
> County obesity rate: 32.8%
> Statewide obesity rate: 31.1% (13th highest)
> Adults who do not exercise: 27.8%
> Adults with diabetes: 12.8%

9. Florida
> Most obese county: Liberty County
> County obesity rate: 39.6%
> Statewide obesity rate: 26.4% (tied-13th lowest)
> Adults who do not exercise: 29.6%
> Adults with diabetes: 13.4%

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10. Georgia
> Most obese county: Clayton County
> County obesity rate: 38.0%
> Statewide obesity rate: 30.3% (18th highest)
> Adults who do not exercise: 25.3%
> Adults with diabetes: 11.6%

11. Hawaii
> Most obese county: Hawaii County
> County obesity rate: 22.7%
> Statewide obesity rate: 21.8% (2nd lowest)
> Adults who do not exercise: 19.4%
> Adults with diabetes: 8.1%

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12. Idaho
> Most obese county: Minidoka County
> County obesity rate: 34.2%
> Statewide obesity rate: 29.6% (tied-23rd highest)
> Adults who do not exercise: 18.3%
> Adults with diabetes: 10.8%

13. Illinois
> Most obese county: Adams County
> County obesity rate: 37.0%
> Statewide obesity rate: 29.4% (tied-25th highest)
> Adults who do not exercise: 24.4%
> Adults with diabetes: 10.1%

14. Indiana
> Most obese county: Lawrence County
> County obesity rate: 38.2%
> Statewide obesity rate: 31.8% (9th highest)
> Adults who do not exercise: 30.6%
> Adults with diabetes: 15.1%

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15. Iowa
> Most obese county: Union County
> County obesity rate: 37.8%
> Statewide obesity rate: 31.3% (12th highest)
> Adults who do not exercise: 26.4%
> Adults with diabetes: 11.8%

16. Kansas
> Most obese county: Seward County
> County obesity rate: 38.6%
> Statewide obesity rate: 30.0% (tied-19th highest)
> Adults who do not exercise: 25.6%
> Adults with diabetes: 8.3%

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17. Kentucky
> Most obese county: Leslie County
> County obesity rate: 43.2%
> Statewide obesity rate: 33.2% (5th highest)
> Adults who do not exercise: 34.3%
> Adults with diabetes: 16.0%

18. Louisiana
> Most obese county: East Carroll Parish
> County obesity rate: 42.1%
> Statewide obesity rate: 33.1% (6th highest)
> Adults who do not exercise: 36.4%
> Adults with diabetes: 16.3%

19. Maine
> Most obese county: Somerset County
> County obesity rate: 35.0%
> Statewide obesity rate: 28.9% (24th lowest)
> Adults who do not exercise: 24.8%
> Adults with diabetes: 11.5%

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20. Maryland
> Most obese county: Somerset County
> County obesity rate: 42.2%
> Statewide obesity rate: 28.3% (22nd lowest)
> Adults who do not exercise: 30.6%
> Adults with diabetes: 13.7%

21. Massachusetts
> Most obese county: Bristol County
> County obesity rate: 28.3%
> Statewide obesity rate: 23.6% (3rd lowest)
> Adults who do not exercise: 25.1%
> Adults with diabetes: 11.1%

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22. Michigan
> Most obese county: Saginaw County
> County obesity rate: 38.9%
> Statewide obesity rate: 31.5% (11th highest)
> Adults who do not exercise: 23.1%
> Adults with diabetes: 12.8%

23. Minnesota
> Most obese county: Pine County
> County obesity rate: 36.2%
> Statewide obesity rate: 25.5% (10th lowest)
> Adults who do not exercise: 26.8%
> Adults with diabetes: 10.6%

24. Mississippi
> Most obese county: Claiborne County
> County obesity rate: 47.6%
> Statewide obesity rate: 35.1% (tied-the highest)
> Adults who do not exercise: 34.5%
> Adults with diabetes: 17.0%

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25. Missouri
> Most obese county: Saline County
> County obesity rate: 37.6%
> Statewide obesity rate: 30.4% (tied-16th highest)
> Adults who do not exercise: 29.7%
> Adults with diabetes: 11.0%

26. Montana
> Most obese county: Big Horn County
> County obesity rate: 38.8%
> Statewide obesity rate: 24.6% (6th lowest)
> Adults who do not exercise: 25.9%
> Adults with diabetes: 13.4%

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27. Nebraska
> Most obese county: Thurston County
> County obesity rate: 41.8%
> Statewide obesity rate: 29.6% (tied-23rd highest)
> Adults who do not exercise: 29.7%
> Adults with diabetes: 16.8%

28. Nevada
> Most obese county: Nye County
> County obesity rate: 31.5%
> Statewide obesity rate: 26.2% (11th lowest)
> Adults who do not exercise: 29.7%
> Adults with diabetes: 12.5%

29. New Hampshire
> Most obese county: Belknap County
> County obesity rate: 31.3%
> Statewide obesity rate: 26.7% (16th lowest)
> Adults who do not exercise: 22.6%
> Adults with diabetes: 10.6%

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30. New Jersey
> Most obese county: Cumberland County
> County obesity rate: 34.5%
> Statewide obesity rate: 26.3% (12th lowest)
> Adults who do not exercise: 28.3%
> Adults with diabetes: 11.6%

31. New Mexico
> Most obese county: McKinley County
> County obesity rate: 35.1%
> Statewide obesity rate: 26.4% (tied-13th lowest)
> Adults who do not exercise: 24.3%
> Adults with diabetes: 13.6%

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32. New York
> Most obese county: Lewis County
> County obesity rate: 33.7%
> Statewide obesity rate: 25.4% (9th lowest)
> Adults who do not exercise: 21.4%
> Adults with diabetes: 9.9%

33. North Carolina
> Most obese county: Edgecombe County
> County obesity rate: 40.8%
> Statewide obesity rate: 29.4% (tied-25th highest)
> Adults who do not exercise: 32.1%
> Adults with diabetes: 16.4%

34. North Dakota
> Most obese county: Rolette County
> County obesity rate: 41.4%
> Statewide obesity rate: 31.0% (14th highest)
> Adults who do not exercise: 29.6%
> Adults with diabetes: 12.9%

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35. Ohio
> Most obese county: Lawrence County
> County obesity rate: 38.8%
> Statewide obesity rate: 30.4% (tied-16th highest)
> Adults who do not exercise: 35.6%
> Adults with diabetes: 15.7%

36. Oklahoma
> Most obese county: Washita County
> County obesity rate: 40.6%
> Statewide obesity rate: 32.5% (7th highest)
> Adults who do not exercise: 29.7%
> Adults with diabetes: 12.6%

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37. Oregon
> Most obese county: Polk County
> County obesity rate: 34.5%
> Statewide obesity rate: 26.5% (15th lowest)
> Adults who do not exercise: 15.9%
> Adults with diabetes: 9.3%

38. Pennsylvania
> Most obese county: Fayette County
> County obesity rate: 38.5%
> Statewide obesity rate: 30.0% (tied-19th highest)
> Adults who do not exercise: 30.7%
> Adults with diabetes: 15.9%

39. Rhode Island
> Most obese county: Kent County
> County obesity rate: 28.8%
> Statewide obesity rate: 27.3% (20th lowest)
> Adults who do not exercise: 21.9%
> Adults with diabetes: 9.9%

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40. South Carolina
> Most obese county: Lee County
> County obesity rate: 44.3%
> Statewide obesity rate: 31.7% (10th highest)
> Adults who do not exercise: 30.3%
> Adults with diabetes: 16.9%

41. South Dakota
> Most obese county: Oglala Lakota County
> County obesity rate: 42.9%
> Statewide obesity rate: 29.9% (21st highest)
> Adults who do not exercise: 21.6%
> Adults with diabetes: 15.8%

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42. Tennessee
> Most obese county: McNairy County
> County obesity rate: 38.6%
> Statewide obesity rate: 33.7% (4th highest)
> Adults who do not exercise: 35.4%
> Adults with diabetes: 16.9%

43. Texas
> Most obese county: Angelina County
> County obesity rate: 37.5%
> Statewide obesity rate: 30.9% (15th highest)
> Adults who do not exercise: 29.4%
> Adults with diabetes: 12.9%

44. Utah
> Most obese county: Box Elder County
> County obesity rate: 33.5%
> Statewide obesity rate: 24.1% (tied-4th lowest)
> Adults who do not exercise: 20.3%
> Adults with diabetes: 9.9%

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45. Vermont
> Most obese county: Essex County
> County obesity rate: 29.8%
> Statewide obesity rate: 24.7% (7th lowest)
> Adults who do not exercise: 26.7%
> Adults with diabetes: 10.2%

46. Virginia
> Most obese county: Petersburg city
> County obesity rate: 41.4%
> Statewide obesity rate: 27.2% (tied-18th lowest)
> Adults who do not exercise: 26.0%
> Adults with diabetes: 15.6%

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47. Washington
> Most obese county: Grays Harbor County
> County obesity rate: 36.9%
> Statewide obesity rate: 27.2% (tied-18th lowest)
> Adults who do not exercise: 25.5%
> Adults with diabetes: 11.6%

48. West Virginia
> Most obese county: McDowell County
> County obesity rate: 42.1%
> Statewide obesity rate: 35.1% (tied-the highest)
> Adults who do not exercise: 37.5%
> Adults with diabetes: 17.6%

49. Wisconsin
> Most obese county: Menominee County
> County obesity rate: 42.5%
> Statewide obesity rate: 29.8% (22nd highest)
> Adults who do not exercise: 29.4%
> Adults with diabetes: 13.9%

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50. Wyoming
> Most obese county: Campbell County
> County obesity rate: 34.3%
> Statewide obesity rate: 27.8% (21st lowest)
> Adults who do not exercise: 24.2%
> Adults with diabetes: 7.0%

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