According to multiple studies, obesity — and even being overweight — can shave years off the average lifespan — up to 14 years in extreme obesity cases. Despite the known dangers, including many associated diseases, the U.S. obesity rate has doubled since the early 1960s, and today obesity is the second leading cause of premature death in the country. Most Americans today are at least overweight.

Obesity is highly prevalent throughout the country — at least one in five Americans are obese in every state. However, some areas of the country have much higher rates of obesity than others.

24/7 Wall St. reviewed the adult obesity rate in every state. Southern states tend to have higher obesity rates and account for nine of the 10 states with the highest obesity rates. Louisiana tops the list with the highest obesity rate — some 36.2% of adult residents are considered obese. By contrast, 20.2% of adults in Colorado are obese, the lowest rate of any state.

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

While diet and exercise are the most important aspects of maintaining a healthy weight, other factors can also contribute to higher obesity rates. For example, states with the highest rates of obesity tend to have low incomes and high poverty rates. Residents who earn low incomes may not be able to afford a healthy diet, and they may have limited access to healthy foods as well as exercise opportunities.

For an individual on a tight budget, only the cheapest foods may be an option, yet many of the cheapest foods available are calorie-dense and nutritionally poor. A healthy diet rich in fruits and vegetables costs about $46 more per month than a less healthy diet.

It can also be difficult to maintain exercise habits in many of the states with high obesity rates. The percentages of adults who report no exercise during their leisure time are higher in these areas, likely due in part to lower access to exercise venues.

In Mississippi, the state with the third highest obesity rate, only 57.5% of residents live close to a place to exercise. On the other hand, in Colorado, the least obese state, 91.3% of the population lives within a 5-10 minute commute to a gym or park. Further, because Mississippi’s poverty rate is nearly double Colorado’s, even residents near a gym may not be able to afford a membership.

To identify the states with the highest rates of obesity, 24/7 Wall St. reviewed the 2015 adult obesity rate in every state with data from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System. Obesity is defined as having a body mass index over 30. The share of overweight — a BMI between 25-30 — adults, and the physical inactivity rate also came from the CDC. Premature death rates per 100,000 residents came from County Health Rankings and Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program.

These are the states with the highest obesity rates.

50. Colorado
> Adult obesity rate: 20.2%
> Adults overweight and obese: 56.6% (the lowest)
> Adults who do not exercise: 17.9% (the lowest)
> Premature (before 75) deaths per 100K: 279 (7th lowest)

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49. Hawaii
> Adult obesity rate: 22.7%
> Adults overweight and obese: 57.0% (2nd lowest)
> Adults who do not exercise: 22.5% (tied-12th lowest)
> Premature (before 75) deaths per 100K: 278 (6th lowest)

48. Montana
> Adult obesity rate: 23.6%
> Adults overweight and obese: 61.0% (8th lowest)
> Adults who do not exercise: 22.5% (tied-12th lowest)
> Premature (before 75) deaths per 100K: 345 (20th highest)

47. California
> Adult obesity rate: 24.2%
> Adults overweight and obese: 60.4% (7th lowest)
> Adults who do not exercise: 20.0% (4th lowest)
> Premature (before 75) deaths per 100K: 269 (3rd lowest)

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46. Massachusetts
> Adult obesity rate: 24.3%
> Adults overweight and obese: 59.7% (tied-4th lowest)
> Adults who do not exercise: 26.5% (tied-21st highest)
> Premature (before 75) deaths per 100K: 275 (4th lowest)

45. Utah
> Adult obesity rate: 24.5%
> Adults overweight and obese: 59.7% (tied-4th lowest)
> Adults who do not exercise: 20.3% (5th lowest)
> Premature (before 75) deaths per 100K: 290 (11th lowest)

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44. New York
> Adult obesity rate: 25.0%
> Adults overweight and obese: 59.5% (3rd lowest)
> Adults who do not exercise: 29.3% (12th highest)
> Premature (before 75) deaths per 100K: 277 (5th lowest)

43. Vermont
> Adult obesity rate: 25.1%
> Adults overweight and obese: 59.8% (6th lowest)
> Adults who do not exercise: 22.2% (11th lowest)
> Premature (before 75) deaths per 100K: 289 (10th lowest)

42. Connecticut
> Adult obesity rate: 25.3%
> Adults overweight and obese: 61.7% (9th lowest)
> Adults who do not exercise: 23.5% (16th lowest)
> Premature (before 75) deaths per 100K: 266 (2nd lowest)

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41. New Jersey
> Adult obesity rate: 25.6%
> Adults overweight and obese: 63.4% (13th lowest)
> Adults who do not exercise: 27.2% (16th highest)
> Premature (before 75) deaths per 100K: 280 (8th lowest)

40. Rhode Island
> Adult obesity rate: 26.0%
> Adults overweight and obese: 62.7% (11th lowest)
> Adults who do not exercise: 28.1% (13th highest)
> Premature (before 75) deaths per 100K: 303 (14th lowest)

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39. Minnesota
> Adult obesity rate: 26.1%
> Adults overweight and obese: 62.8% (12th lowest)
> Adults who do not exercise: 21.8% (9th lowest)
> Premature (before 75) deaths per 100K: 262 (the lowest)

38. New Hampshire
> Adult obesity rate: 26.3%
> Adults overweight and obese: 63.6% (14th lowest)
> Adults who do not exercise: 22.6% (tied-14th lowest)
> Premature (before 75) deaths per 100K: 290 (12th lowest)

37. Washington
> Adult obesity rate: 26.4%
> Adults overweight and obese: 62.5% (10th lowest)
> Adults who do not exercise: 19.0% (3rd lowest)
> Premature (before 75) deaths per 100K: 286 (9th lowest)

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36. Nevada
> Adult obesity rate: 26.7%
> Adults overweight and obese: 64.7% (20th lowest)
> Adults who do not exercise: 24.7% (tied-18th lowest)
> Premature (before 75) deaths per 100K: 361 (16th highest)

35. Florida
> Adult obesity rate: 26.8%
> Adults overweight and obese: 64.1% (tied-15th lowest)
> Adults who do not exercise: 26.2% (tied-24th highest)
> Premature (before 75) deaths per 100K: 326 (25th highest)

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34. Arizona
> Adult obesity rate: 28.4%
> Adults overweight and obese: 65.3% (23rd lowest)
> Adults who do not exercise: 24.7% (tied-18th lowest)
> Premature (before 75) deaths per 100K: 324 (25th lowest)

33. Idaho
> Adult obesity rate: 28.6%
> Adults overweight and obese: 65.2% (22nd lowest)
> Adults who do not exercise: 21.2% (6th lowest)
> Premature (before 75) deaths per 100K: 310 (17th lowest)

32. New Mexico
> Adult obesity rate: 28.8%
> Adults overweight and obese: 64.5% (tied-17th lowest)
> Adults who do not exercise: 22.6% (tied-14th lowest)
> Premature (before 75) deaths per 100K: 374 (14th highest)

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31. Maryland
> Adult obesity rate: 28.9%
> Adults overweight and obese: 65.0% (21st lowest)
> Adults who do not exercise: 24.1% (17th lowest)
> Premature (before 75) deaths per 100K: 319 (20th lowest)

30. Wyoming
> Adult obesity rate: 29.0%
> Adults overweight and obese: 65.4% (24th lowest)
> Adults who do not exercise: 26.2% (tied-24th highest)
> Premature (before 75) deaths per 100K: 348 (18th highest)

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29. Virginia
> Adult obesity rate: 29.2%
> Adults overweight and obese: 64.1% (tied-15th lowest)
> Adults who do not exercise: 25.1% (22nd lowest)
> Premature (before 75) deaths per 100K: 314 (19th lowest)

28. Delaware
> Adult obesity rate: 29.7%
> Adults overweight and obese: 66.9% (14th highest)
> Adults who do not exercise: 29.4% (tied-10th highest)
> Premature (before 75) deaths per 100K: 340 (24th highest)

27. Ohio
> Adult obesity rate: 29.8%
> Adults overweight and obese: 66.5% (tied-16th highest)
> Adults who do not exercise: 27.0% (tied-17th highest)
> Premature (before 75) deaths per 100K: 382 (12th highest)

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26. Alaska
> Adult obesity rate: 29.8%
> Adults overweight and obese: 67.2% (tied-10th highest)
> Adults who do not exercise: 22.0% (10th lowest)
> Premature (before 75) deaths per 100K: 347 (19th highest)

25. Pennsylvania
> Adult obesity rate: 30.0%
> Adults overweight and obese: 66.2% (tied-21st highest)
> Adults who do not exercise: 27.8% (14th highest)
> Premature (before 75) deaths per 100K: 342 (22nd highest)

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24. Maine
> Adult obesity rate: 30.0%
> Adults overweight and obese: 66.5% (tied-16th highest)
> Adults who do not exercise: 24.8% (tied-20th lowest)
> Premature (before 75) deaths per 100K: 321 (23rd lowest)

23. Oregon
> Adult obesity rate: 30.1%
> Adults overweight and obese: 64.6% (19th lowest)
> Adults who do not exercise: 18.8% (2nd lowest)
> Premature (before 75) deaths per 100K: 310 (16th lowest)

22. North Carolina
> Adult obesity rate: 30.1%
> Adults overweight and obese: 65.9% (25th highest)
> Adults who do not exercise: 26.2% (tied-24th highest)
> Premature (before 75) deaths per 100K: 363 (15th highest)

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21. South Dakota
> Adult obesity rate: 30.4%
> Adults overweight and obese: 64.5% (tied-17th lowest)
> Adults who do not exercise: 21.5% (7th lowest)
> Premature (before 75) deaths per 100K: 323 (24th lowest)

20. Wisconsin
> Adult obesity rate: 30.7%
> Adults overweight and obese: 66.0% (24th highest)
> Adults who do not exercise: 21.6% (8th lowest)
> Premature (before 75) deaths per 100K: 301 (13th lowest)

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19. Georgia
> Adult obesity rate: 30.7%
> Adults overweight and obese: 65.5% (25th lowest)
> Adults who do not exercise: 27.3% (15th highest)
> Premature (before 75) deaths per 100K: 377 (13th highest)

18. Illinois
> Adult obesity rate: 30.8%
> Adults overweight and obese: 66.2% (tied-21st highest)
> Adults who do not exercise: 24.8% (tied-20th lowest)
> Premature (before 75) deaths per 100K: 320 (22nd lowest)

17. North Dakota
> Adult obesity rate: 31.0%
> Adults overweight and obese: 67.0% (tied-12th highest)
> Adults who do not exercise: 26.8% (19th highest)
> Premature (before 75) deaths per 100K: 319 (21st lowest)

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16. Michigan
> Adult obesity rate: 31.2%
> Adults overweight and obese: 66.3% (tied-19th highest)
> Adults who do not exercise: 25.5% (24th lowest)
> Premature (before 75) deaths per 100K: 360 (17th highest)

15. Indiana
> Adult obesity rate: 31.3%
> Adults overweight and obese: 66.5% (tied-16th highest)
> Adults who do not exercise: 29.4% (tied-10th highest)
> Premature (before 75) deaths per 100K: 387 (10th highest)

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14. Nebraska
> Adult obesity rate: 31.4%
> Adults overweight and obese: 67.0% (tied-12th highest)
> Adults who do not exercise: 25.3% (23rd lowest)
> Premature (before 75) deaths per 100K: 307 (15th lowest)

13. South Carolina
> Adult obesity rate: 31.7%
> Adults overweight and obese: 66.2% (tied-21st highest)
> Adults who do not exercise: 26.7% (20th highest)
> Premature (before 75) deaths per 100K: 405 (9th highest)

12. Iowa
> Adult obesity rate: 32.1%
> Adults overweight and obese: 66.6% (15th highest)
> Adults who do not exercise: 26.3% (23rd highest)
> Premature (before 75) deaths per 100K: 311 (18th lowest)

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11. Texas
> Adult obesity rate: 32.4%
> Adults overweight and obese: 68.7% (tied-6th highest)
> Adults who do not exercise: 29.5% (9th highest)
> Premature (before 75) deaths per 100K: 342 (23rd highest)

10. Missouri
> Adult obesity rate: 32.4%
> Adults overweight and obese: 66.3% (tied-19th highest)
> Adults who do not exercise: 27.0% (tied-17th highest)
> Premature (before 75) deaths per 100K: 386 (11th highest)

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9. Tennessee
> Adult obesity rate: 33.8%
> Adults overweight and obese: 68.7% (tied-6th highest)
> Adults who do not exercise: 30.4% (8th highest)
> Premature (before 75) deaths per 100K: 436 (8th highest)

8. Oklahoma
> Adult obesity rate: 33.9%
> Adults overweight and obese: 69.0% (5th highest)
> Adults who do not exercise: 33.2% (3rd highest)
> Premature (before 75) deaths per 100K: 459 (4th highest)

7. Kansas
> Adult obesity rate: 34.2%
> Adults overweight and obese: 68.0% (9th highest)
> Adults who do not exercise: 26.5% (tied-21st highest)
> Premature (before 75) deaths per 100K: 344 (21st highest)

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6. Arkansas
> Adult obesity rate: 34.5%
> Adults overweight and obese: 69.5% (3rd highest)
> Adults who do not exercise: 34.2% (2nd highest)
> Premature (before 75) deaths per 100K: 453 (5th highest)

5. Kentucky
> Adult obesity rate: 34.6%
> Adults overweight and obese: 67.2% (tied-10th highest)
> Adults who do not exercise: 32.5% (4th highest)
> Premature (before 75) deaths per 100K: 452 (7th highest)

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4. West Virginia
> Adult obesity rate: 35.6%
> Adults overweight and obese: 71.1% (the highest)
> Adults who do not exercise: 30.8% (7th highest)
> Premature (before 75) deaths per 100K: 471 (2nd highest)

3. Mississippi
> Adult obesity rate: 35.6%
> Adults overweight and obese: 70.1% (2nd highest)
> Adults who do not exercise: 36.8% (the highest)
> Premature (before 75) deaths per 100K: 496 (the highest)

2. Alabama
> Adult obesity rate: 35.6%
> Adults overweight and obese: 68.6% (8th highest)
> Adults who do not exercise: 31.9% (tied-5th highest)
> Premature (before 75) deaths per 100K: 464 (3rd highest)

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1. Louisiana
> Adult obesity rate: 36.2%
> Adults overweight and obese: 69.2% (4th highest)
> Adults who do not exercise: 31.9% (tied-5th highest)
> Premature (before 75) deaths per 100K: 452 (6th highest)

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