Obesity in the United States continues to rise, and the problem does not appear to be getting any better. According to the Centers for Disease Control and Prevention, the national obesity rate rose again in 2013 to 28.3% of the adult population. The growing epidemic is placing an increasingly greater burden on our health care system, and according to a 2013 study, the annual obesity-related health care costs are estimated to be as high as $210 billion.

Based on the Centers for Disease Control and Prevention data on obesity, 24/7 Wall St. reviewed the 10 states with the highest and the 10 states with the lowest obesity rates in 2013. West Virginia and Mississippi tied for the worst obesity rates in the country at just over 35% of adults. Colorado remained the state with the least severe problem, with an adult obesity rate of 21.3%.

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

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

Obesity is a complicated issue, and a wide range of factors can contribute to the problem in a given area. Diet, not surprisingly, plays a major role. All but one of the 10 states with the highest obesity rates were in the bottom 10 for daily fruit consumption, and adults in all of the 10 states were less likely than the average American to eat vegetables on a daily basis. The data show that exercise is just as important as diet. The nine states with the lowest rates of physical activity had the nine highest rates of obesity.

Diet and exercise, however, are not the only elements that can affect obesity rates. The CDC explains that a variety of social and economic factors also can contribute to high obesity rates. For example, lower-income families are less likely to be able to afford healthy foods. Each of the states with the highest obesity rates had above-average poverty rates.

Education also has been shown to be a factor in health decisions and outcomes. A more educated population is more likely to be aware of the importance of healthy choices. And people with better education are also more likely to have higher-paying jobs and live in areas where they can have access to healthy food and safe exercise options. Nationally, just under 30% of adults had a bachelor’s degree or higher. In all but one of the 10 states with the highest obesity rates, less than 25% adults had a such an education.

While obesity is itself defined as a negative health outcome, it is also linked to other health conditions, including high blood pressure, diabetes, heart disease, and even some forms of cancer. In states where obesity is lower, these health outcomes are much less prevalent. All but one of the 10 states with the lowest obesity rates had below-average rates of high blood pressure. Rates of diabetes, high cholesterol, and heart disease-related deaths were also below average in nearly all of the states with the lowest obesity rates.

If obesity rates continue to increase, it is the states with already nearly a third of the population facing obesity that will likely experience the most severe consequences. If the problem continues to worsen, rates of serious health problems in states such as Mississippi and West Virginia will certainly rise, and the costs for treating these conditions will continue to pile on.

To determine the states with the highest and lowest obesity rates, 24/7 Wall St. reviewed obesity rates for 2013 from the Centers for Disease Control and Prevention (CDC). We also examined obesity rates for 2011 and 2012 from the same survey. Also from the CDC, we considered the percentage of people in each state who reported consuming fruits and vegetables daily in 2011, as well as the median daily intake of fruits and vegetables. Cancer rates and high blood pressure rates per 100,000 people also came from the CDC and are for 2011. Additionally, the percentage of adults diagnosed with diabetes in 2012 comes from the CDC. Data on cholesterol and heart disease per 100,000 people in 2013 come from the Kaiser Family Foundation. From the U.S. Census Bureau’s 2013 American Community Survey, we looked at high school and bachelor’s degree educational attainment rates, median household income, and poverty rates. The percentage of adults that are physically inactive come from County Health Rankings & Roadmaps.