The Most Obese County in Every State

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41. South Dakota
> Most obese county:
Oglala Lakota
> County obesity rate: 44.5%
> Statewide obesity rate: 29.8%
> Pct. of adults who exercise regularly: 76.2%
> Share of adults reporting fair or poor health: 32.5%

Oglala Lakota County is entirely within the Pine Ridge Indian Reservation, an area plagued by extreme poverty, high infant mortality, and suicide. The Oglala Sioux tribe struggles not just with obesity — the county’s 44.5% obesity rate is the fifth highest of all U.S. counties — but with many other severe health issues as well. The incidence of premature death in Oglala Lakota County, estimated at 23,876 years lost per 100,000 people, is the second highest of all U.S. counties.

42. Tennessee
> Most obese county:
Haywood
> County obesity rate: 41.3%
> Statewide obesity rate: 32.2%
> Pct. of adults who exercise regularly: 62.1%
> Share of adults reporting fair or poor health: 29.8%

Inadequate exercise may be one factor impacting the health of Haywood County. Just 16.4% of Haywood County residents have access to recreational opportunities compared to 69.3% of Tennessee residents who do. Similarly, 62.1% of adults exercise regularly, a smaller share than the 67.8% of Tennessee adults who do — itself the second lowest activity rate of any state in the nation.

43. Texas
> Most obese county:
Jefferson
> County obesity rate: 36.9%
> Statewide obesity rate: 28.4%
> Pct. of adults who exercise regularly: 70.0%
> Share of adults reporting fair or poor health: 19.5%

Insufficient diet and exercise may be contributing to Jefferson County’s high obesity rate. Across the county, 24.9% of residents lack a reliable source of healthy food, a much higher share than the 17.6% of food insecure Texans. Similarly, 70.0% of county adults exercise regularly, a smaller share than the corresponding 75.9% state activity rate.

44. Utah
> Most obese county:
Box Elder
> County obesity rate: 32.8%
> Statewide obesity rate: 24.9%
> Pct. of adults who exercise regularly: 79.4%
> Share of adults reporting fair or poor health: 12.8%

Despite Box Elder County’s 32.8% obesity rate, the highest in the state, county residents report relatively healthy behaviors. The county has one of the most concentrated Mormon populations in Utah, a religion that largely forbids drinking and smoking. Perhaps as a result, the county’s 9.2% smoking and 11.0% excessive drinking rates are lower than the corresponding state rates and among the lowest in the country.

45. Vermont
> Most obese county:
Orleans
> County obesity rate: 29.9%
> Statewide obesity rate: 24.4%
> Pct. of adults who exercise regularly: 75.2%
> Share of adults reporting fair or poor health: 11.7%

Nearly 30% of Orleans County adults are obese, the largest share of any Vermont county. Obesity can increase the risk of cardiac arrest, stroke, and diabetes, among other diseases, and ultimately lead to premature death. For every 100,000 county residents, 7,059 years of potential life are lost to premature death annually — about 1,500 more years of life lost than the corresponding state figure and the highest incidence of premature death in Vermont.