“Our analysis showed patterns of obesity or overweight for various groups of Americans. All groups consistently increased in obesity or overweight prevalence, but the increase varied by group, making this public health issue complex. More research needs to be completed to look into the underlying causes,” says May A. Beydoun, coauthor of the study and a postdoctoral fellow in the Bloomberg School of Public Health’s Department of International Health. “Obesity is likely to continue to increase, and if nothing is done, it will soon become the leading preventable cause of death in the United States.”

In a related study, the Johns Hopkins co-authors published a research article in the May 7, 2007, issue of the European Journal of Clinical Nutrition that found people purchase foods based on their income level and perception of a food’s health benefit and cost. Ethnicity, gender and environmental factors also impact people’s food choices.

NOTE: Unlike definitions for adults, the Centers for Disease Control and Prevention uses “overweight” to refer to the highest body mass index for children and adolescents. Therefore, it is inaccurate to use the term “obese” when referring to elevated body mass index in this age group.

Most Obese States

West Virginia and Alabama remained as the second and third fattest states this year. The four states of Mississippi, West Virginia, Alabama, and Louisiana have obese populations that exceed 30 percent over a three-year average and two-thirds of the citizens of Mississippi and West Virginia were either overweight or obese by CDC standards in 2007.

Also not faring well this year was Delaware, which rose eight places to tie with North Dakota as the 21st fattest state, from last year’s 29th placing. Delaware’s 3-year obesity rate rose 2.4 percent.

Leanest States

Colorado repeats as the slimmest state, despite a slight increase in obesity of 0.8 percent over three years. Last year Governor Bill Ritter of Colorado said “[W]e’re not spared from the national obesity epidemic, and we must remain vigilant in order to guard against it. We’re doing all we can to encourage Coloradans — especially our kids — to take advantage of the natural resources our state offers in order to stay fit, healthy and happy.”

Hawaii enters the rankings for the first time in 2008 at number 50, the second slimmest state after Colorado. Hawaii had not conducted annual BMI surveys until 2005, so the required three years of data was not available until this year.

Last year California was the only state whose obesity rate held steady. This year it eaked up by 0.4 percent, but because of the overall increase in obesity nationwide California’s ranking dropped five places, from 36th fattest state to 41st fattest state.

The only state to get slimmer this year is not actually a state: the District of Columbia’s three-year obesity rate dropped by 0.1 percent.

Regional Obesity by State Trends

In general, states in the West and New England rank lowest in the fattest states rankings, while states in the South and the Rust Belt tend to rank highest.

The fattest state rankings for this year based on the Behavioral Risk Factor Surveillance System database maintained by the Centers for Disease Control and Prevention. The rankings use a three-year average in order to smooth out statistical fluctuations.

Because of the overall increase in obesity, this year's color coding shifted one percentage point higher to maintain an approximately equal number of states per color. This means that this year’s map cannot be directly compared to last year’s and or any year prior to that.

United States of Obesity: Fattest States 2008
2007 Rank	2008 Rank	State	% Obese 2007	% Obese or Overweight 2007	3-year Obesity Average	% Obesity Change	Ranking Change
1	1	Mississippi	32.6	68.1	31.6	1.0	0
2	2	West Virginia	30.3	68.0	30.6	0.9	0
3	3	Alabama	30.9	66.6	30.1	0.7	0
4	4	Louisiana	30.7	65.2	29.5	1.3	0
5	5	South Carolina	29.0	65.3	29.2	1.3	0
6	6	Tennessee	30.7	67.4	29.0	1.2	0
7	7	Kentucky	28.7	69.1	28.4	1.0	0
9	8	Oklahoma	28.8	65.1	28.1	1.3	1
8		Arkansas	29.3	65.6	28.1	1.1	0
9	10	Michigan	28.2	64.3	27.7	0.9	-1
9	11	Indiana	27.4	63.2	27.5	0.6	-2
14	12	Georgia	28.7	65.0	27.4	1.3	2
12		Missouri	28.2	63.3	27.4	1.1	0
16	14	Alaska	28.2	65.1	27.3	1.5	2
12	15	Texas	28.6	65.8	27.2	0.9	-3
17	16	North Carolina	28.7	64.6	27.1	1.5	1
15	17	Ohio	28.1	63.5	26.9	0.9	-2
18	18	Nebraska	26.5	64.7	26.5	1.1	0
20	19	Iowa	27.7	64.7	26.3	1.4	1
20	20	South Dakota	27.2	65.5	26.0	1.1	0
19	21	North Dakota	27.0	64.9	25.9	0.8	-2
29		Delaware	28.2	65.0	25.9	2.4	8
27	23	Kansas	27.7	63.8	25.8	1.5	4
23	24	Pennsylvania	27.8	62.7	25.7	1.2	-1
24	25	Virginia	26.3	62.9	25.5	1.1	-1
22	26	Wisconsin	25.3	62.3	25.4	0.7	-4
24	27	Illinois	25.6	63.0	25.3	0.9	-3
24	28	Maryland	26.3	62.7	25.2	0.8	-4
30	29	Oregon	26.3	62.0	25.0	1.7	1
28	30	Minnesota	26.0	62.0	24.8	1.1	-2
32	31	Idaho	25.1	63.1	24.6	1.4	1
31	32	Washington	25.9	62.1	24.5	1.2	-1
35	33	Wyoming	24.5	62.2	24.0	1.2	2
32	34	Maine	25.2	62.9	23.7	0.6	-2
37	35	Nevada	24.6	63.0	23.6	1.2	2
37	36	New York	25.5	61.9	23.5	1.1	1
37		New Hampshire	25.1	61.8	23.5	1.2	1
34	38	Florida	24.1	62.1	23.3	0.4	-4
43		Arizona	25.8	62.6	23.3	1.5	5
42	40	New Mexico	25.1	60.8	23.2	1.2	2
36	41	California	23.3	59.0	23.1	0.4	-5
40	42	New Jersey	24.1	62.3	22.9	0.7	-2
40	43	District of Columbia	22.2	55.3	22.1	-0.1	-3
44	44	Utah	22.4	58.0	21.8	0.7	0
45	45	Montana	22.6	61.8	21.7	1.0	0
46	46	Rhode Island	21.7	60.8	21.4	0.9	0
48	47	Vermont	21.9	58.8	21.1	1.1	1
49	48	Massachusetts	21.7	58.9	20.9	1.1	1
47	49	Connecticut	21.7	59.2	20.8	0.7	-2
N.A.	50	Hawaii	21.7	56.8	20.7	N.A.	N.A.
50	51	Colorado	19.3	55.7	18.4	0.8	-1
Obesity is defined as a BMI of 30.0 or over, overweight as a BMI of 25.0 to 29.9.

Obesity blamed for doubling rate of diabetes cases

The nation's obesity epidemic is exacting a heavy toll: The rate of new diabetes cases nearly doubled in the United States in the past 10 years, the government said Thursday. The highest rates were in the South, according to the first state-by-state review of new diagnoses. The worst was in West Virginia, where about 13 in 1,000 adults were diagnosed with the disease in 2005-07. The lowest was in Minnesota, where the rate was 5 in 1,000.

Nationally, the rate of new cases climbed from about 5 per 1,000 in the mid-1990s to 9 per 1,000 in the middle of this decade.

Roughly 90 percent of cases are Type 2 diabetes, the form linked to obesity.

The findings dovetail with trends seen in obesity and lack of exercise — two health measures where Southern states also rank at the bottom.

"It isn't surprising the problem is heaviest in the South — no pun intended," agreed Matt Petersen, who oversees data and statistics for the American Diabetes Association.

The study, led by Karen Kirtland of the Centers for Disease Control and Prevention, provides an up-to-date picture of where the disease is exploding. The information should be a big help as the government and health insurance companies decide where to focus prevention campaigns, Petersen said.

Diabetes was the nation's seventh-leading cause of death in 2006, according to the CDC. More than 23 million Americans have diabetes, and the number is rapidly growing. About 1.6 million new cases were diagnosed among adults last year.

In Type 2 diabetes, cells do not properly use insulin, a hormone needed to convert sugar into energy, and the pancreas gradually loses its ability to produce it. The illness can cause sugar to build up in the body, leading to complications such as heart disease, blindness, kidney failure and poor circulation that leads to foot amputations.

The study involved a random-digit-dialed survey of more than 260,000 adults. Participants were asked if they had ever been told by a doctor that they have diabetes, and when the diagnosis was made. The comparisons between 1995-97 and 2005-07 covered only the 33 states for which the CDC had complete data for both time periods.

The researchers had data for 40 states for the years 2005-07.

West Virginia, South Carolina, Alabama, Georgia, Texas and Tennessee had the highest rates, all at 11 cases per 1,000 or higher. Puerto Rico was about as high as West Virginia. Minnesota, Hawaii and Wyoming had the lowest rates.

It is not entirely clear why some states were worse than others. Older people, blacks and Hispanics tend to have higher rates of Type 2 diabetes, and the South has large concentrations of all three groups. However, West Virginia is overwhelmingly white.

The report asked about diagnosed diabetes only. Because an estimated one in four diabetics have not been diagnosed, the findings probably underestimate the problem, said Angela Liese, a diabetes researcher at the University of South Carolina.

The underestimates may be particularly bad in the rural South and other areas where patients have trouble getting health care, she noted.