Almost half of adults in the United States are projected to be obese, not just overweight, by 2030, according to estimates published in December 2019 in the New England Journal of Medicine. Nearly one in four people will be morbidly obese, meaning carrying about 100 pounds over one’s normal body weight.

In the age of a coronavirus pandemic, this is especially worrisome as obesity, which decreases lung capacity, may triple the risk of hospitalization due to a COVID-19 infection, according to the Centers for Disease Control and Prevention.

24/7 Tempo analyzed county-level data from the 2020 County Health Rankings & Roadmaps report, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute to determine the most obese city in the United States. We aggregated county-level statistics to metropolitan statistical areas.

Many of the metro areas with high obesity rates also tend to have low-income populations. People with lower incomes are less able to afford proper medical care, as well as a healthy lifestyle, and have less access to healthy foods or gyms. Only one of the 50 cities with the highest obesity rates that were finalists for the most obese city has a median annual household income that is higher than the U.S. median of $65,712.

Though the underlying causes of obesity are many, some are within one’s control. Others, like genetics, are not. The health outcomes of being obese are clearer. One of them is diabetes. All but three of the most obese cities on our finalist list have an adult diabetes rate lower than the U.S. rate of 10.3%. Click here to see the 10 warning signs you may have diabetes.

Obesity is associated with a reduced quality of life, chronic conditions such as hypertension and diseases such as heart disease and cancer that are among the leading causes of death. Only seven of the 50 metro areas that were finalists have a lower share of adults reporting being in poor or fair health than the U.S. average of 17.2%.

Health experts have pointed to several lifestyle factors as likely contributing to the excess weight problem. Among them are a sedentary lifestyle and the consumption of high-calorie diets, including large sugary beverages.

Keeping active has been shown to help people maintain a healthy weight. Nationwide, 23.0% of adults report exercising on a regular basis. Of the 50 most obese cities on the finalist list, only two metro areas have a lower share of adults who don’t exercise regularly.

To determine the most obese city in the United States, 24/7 Tempo reviewed obesity data for all 384 metro areas in the country. The obesity rates (the share of adult residents who report a body mass index of 30 or greater) came from the 2020 County Health Rankings & Roadmaps, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

The age-adjusted percentage of the total population 20 years and over diagnosed with diabetes in 2016, the latest year for which data is available, also came from the 2020 County Health Rankings & Roadmaps.

Age-adjusted rates of diabetes were provided at the county level, which were then aggregated to the metropolitan level using a weighted average, based on the percentage of the 2019 one-year population of each county within each metro area. Population figures, as well as median household income and poverty rate, came from the American Community Survey 2019 1-Year Estimates.

Texarkana, Texas, is the most obese city in America, with a rate of 43.6%, against the U.S. average of 29.0%. In the city, adults who don’t exercise account for 39.2% of the residents, which ranks it first among 384 American cities. The U.S. average is 24.4%. The city’s population over 20 with diabetes is 14.6%, which ranks it 38th out of 384 metros measured. The U.S. average for this is only 10.3%.

Adults in poor or fair health in Texarkana represent 20.5% of adults, which puts its 69th out of 384 metros. The U.S. average for this measure is 17.2%. The city’s median household income is $51,544, which puts it 300th out of 384 metros The U.S. average for this number is $65,712. Texarkana’s population is 149,308.

Click here to see the 50 most obese cities in America.

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