The United States is infamous for its obesity problem, and with good cause. The national obesity rate across the country spiked from 23% to 35% between the late 1980s and the early 2000s. There are a multitude of social and economic factors that predispose certain populations to obesity. High obesity rates can in return detrimentally affect the health and life expectancy of the population.

While the country is facing an obesity crisis, the problem is much more pronounced in certain areas. Obesity rates in each state’s most obese county range from 46.6% in Holmes, Mississippi, to 23.8% in Kalawao County, Hawaii. To identify the most obese county in each state, 24/7 Wall St. reviewed county-level health data from County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program.

In an interview with 24/7 Wall St., Julie Willems Van Dijk, co-director of the County Health Rankings and Roadmaps program at the University of Wisconsin, explained that high obesity rates in the United States can explained that high obesity rates in the United States are due to “a complex interaction of genetics, behavior, and environment.”

Click here to see the most obese counties in each state

Data indeed show that certain environmental conditions and financial circumstances can drastically affect obesity rates in a given population. For example, low income areas are often more likely to have a relatively large share of obese adults, as financial instability can greatly limit healthy food options. “Processed foods or fast foods are generally less expensive than fresh fruits and vegetables or meat,” Willems Van Dijk said. “The affordability of calorie-dense, low-nutrition foods is definitely a factor.” According to the data, the typical household in 39 of these 50 counties earns less than the national median income of $53,700.

A number of these counties are rural. In such areas, the nearest grocery store with healthy food options may be far away. “If you’re fairly low income and the nearest grocery store is five or 10 miles away and you don’t have a car or you don’t have money to put gas in the car you have,” Willems Van Dijk explained.

Sedentary lifestyles are a major causal factor of obesity, Willems Van Dijk further explained. Consequently, obesity rates are often high in areas with limited access to places where residents can be physically active. In 44 of the 50 counties examined, residents have less access to areas for physical activity, such as parks or recreation centers, than the rest of the state. In Menominee County, Wisconsin for example, only 7.4% of residents have access to areas for physical activity. Meanwhile, 81.7% of Wisconsin residents have access to such areas. Perhaps not surprisingly, 41.0% of Menominee County adults are obese, while only 29.4% of Wisconsin adults are obese.

While the underlying causes of obesity are complex, obesity’s effects on the quality and length of life are much clearer. “Obesity leads to so many chronic diseases,” Willems Van Dijk explained that it “predisposes people to early deaths in many ways.” Obesity is linked to diabetes, heart attack, stroke, and high blood pressure. Preventable death before age 75 is more common than it is across the corresponding state in 41 of the the 50 counties examined.

Not only are adults in obese areas more likely to lead shorter lives, but also their lives are far more likely to be difficult. In addition to increased susceptibility to certain chronic diseases, obesity also “brings a myriad of quality of life issues,” Willems Van Dijk said. In 41 of these 50 counties, a larger share of adults report being in fair or poor health than the corresponding statewide share.

To identify the most obese county in every state, 24/7 Wall St. reviewed county-level data from County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program. We also considered individual measures of health outcomes and health factors. The health factors component included measures of healthy behavior, clinical care, social and economic factors, and physical environment measures. Data were compiled from over 20 different sources and are as of the most recent year available. A total of 3,140 counties were considered.

These are the most obese counties in each state.