30 Counties Gaining (and Losing) the Most Weight

January 8, 2018 by Sam Stebbins

Along with the opioid epidemic, obesity is one of the most serious public health challenges in the United States. In much of the country, the problem is only getting worse. Some 27.7% of American adults are dangerously overweight, up from 23.2% 10 years ago.

While the root cause of obesity can change from one individual to the next, the health risks associated with obesity are clear. Obese adults are at higher risk for a host of serious and often deadly diseases and conditions, including heart disease, high blood pressure, certain cancers, and diabetes.

While the incidence of obesity is up 4.5 percentage points nationwide over the past decade, in some regions, the uptick has been far more dramatic. In several counties — primarily in the South — obesity rates are up by over 13 percentage points.

In other parts of the country, however, obesity is less of a problem now than it was a decade ago. Bucking the national trend, several dozen counties have reported a lower obesity rate than 10 years ago. The declines have not been as dramatic as some of the increases, however, and obesity rates in only 15 counties nationwide declined by at least 1 percentage point compared to a decade ago.

24/7 Wall St. reviewed county-level obesity rates from the Centers for Disease Control and Prevention to identify the counties gaining (and losing) the most weight.

Click here to see the counties gaining the most weight.
Click here to see the counties losing the most weight.
Click here to see our detailed findings and methodology.

Counties Gaining the Most Weight

15. Hernando County, Florida
> 10 yr. change in obesity rate: +13.2 ppt
> Obesity rate: 18.9% (2004), 32.1% (2013)
> Adults who are physically inactive: 26.6%
> Median household income: $42,274

Over the past decade, Hernando County, Florida has become considerably less healthy by at least one critical measure — obesity. As recently as 10 years ago, Hernando County’s adult obesity rate was only 18.9%, well below the U.S. obesity rate at the time of 23.2%. According to the latest annual data, the county’s obesity rate has risen to 32.1%, well above the adult obesity rate nationwide of 27.7%.

Obesity is a leading cause of a number of serious and potentially deadly diseases and conditions, including diabetes. As the county’s obesity rate climbed, so did the incidence of diabetes. Some 13.4% of area adults have been diagnosed with diabetes, up from 9.2% a decade ago.

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14. Washita County, Oklahoma
> 10 yr. change in obesity rate: +13.3 ppt
> Obesity rate: 27.3% (2004), 40.6% (2013)
> Adults who are physically inactive: 29.7%
> Median household income: $48,715

After reporting a 13.3 percentage point uptick in adult obesity over the past decade, Washita County, Oklahoma is now one of the most obese counties in the United States. Some 40.6% of county adults are obese, well above the 27.7% of American adults nationwide.

Maintaining a healthy diet is the main way to prevent excess weight gain, but that is not always easy without access to healthy and affordable food. In Washita, some 45.8% of the population live in so-called food deserts without such access, a far greater share than in the vast majority of counties nationwide.

13. Jones County, Iowa
> 10 yr. change in obesity rate: +13.4 ppt
> Obesity rate: 24.2% (2004), 37.6% (2013)
> Adults who are physically inactive: 25.0%
> Median household income: $55,507

A decade ago, approximately than 1 in every 4 adults in Jones County, Iowa were obese. Today, more than one-third are. While obesity has become more of a problem nationwide over the last 10 years, the 13.4 percentage point uptick in Jones County is greater than in all but a dozen other counties.

Obesity is a causal factor for a number of serious diseases and conditions, including diabetes. As the county’s obesity rate climbed, so did the incidence of diabetes. Some 10.2% of Jones County adults have been diagnosed with diabetes, up from only 7.1% 10 years ago.

12. Sharp County, Arkansas
> 10 yr. change in obesity rate: +13.5 ppt
> Obesity rate: 23.8% (2004), 37.3% (2013)
> Adults who are physically inactive: 31.4%
> Median household income: $31,068

Sharp County’s adult obesity rate climbed 13.5 percentage points over the last 10 years — from 23.8% to 37.3%. The increasing incidence of obesity among adults in the county is a magnified version of the national trend. Nationwide, the adult obesity rate climbed from 23.2% to 27.7% over the same period.

Regular physical exercise can be important to maintaining a healthy weight, and the share of adults who are physically active in Sharp County is sliding. Some 31.4% of county adults get no exercise beyond getting up and going to work, down from 30.5% a decade ago.

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11. Lee County, South Carolina
> 10 yr. change in obesity rate: +13.7 ppt
> Obesity rate: 30.6% (2004), 44.3% (2013)
> Adults who are physically inactive: 30.3%
> Median household income: $31,169

Lee County, South Carolina is one of the least healthy counties in the country, at least when it comes to obesity. Some 44.3% of area adults are obese — the county’s obesity rate is not only up from 30.6% a decade ago, but also is higher than in all but nine other counties nationwide.

Healthy diets and lifestyles can be expensive, and lower income households often rely on inexpensive, unhealthy food options. Low incomes may explain the rising obesity in Lee County. The typical county household earns only $31,169 a year, well below the median income across all U.S. households of $55,322.

10. Phillips County, Arkansas
> 10 yr. change in obesity rate: +13.7 ppt
> Obesity rate: 31.8% (2004), 45.5% (2013)
> Adults who are physically inactive: 35.9%
> Median household income: $26,829

The typical household in Phillips County earns only $26,829 a year, less than half the income the typical American household earns annually. Partially because healthy lifestyles and diets can be expensive, poorer areas tend to have higher obesity rates. Phillips County, Arkansas is no exception. Some 45.5% of adults in the county are obese, well above the 27.7% U.S. obesity rate and nearly the highest obesity rate of any U.S county. Obesity in the county also has gotten far worse over the last 10 years. A decade ago, 31.8% of adults in the county were obese.

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9. Calhoun County, Florida
> 10 yr. change in obesity rate: +13.7 ppt
> Obesity rate: 25.7% (2004), 39.4% (2013)
> Adults who are physically inactive: 33.1%
> Median household income: $37,089

Calhoun is one of two Florida counties reporting a near nation-leading uptick in its obesity rate. Some 39.4% of adults in Calhoun County are obese, up 13.7 percentage points from a decade ago when 25.7% of adults were obese.

A healthy diet can be critical to maintaining a healthy weight, but keeping such a diet hinges on access to nutritious and affordable food. One of the most sparsely populated counties in the state, nearly half of all Calhoun County residents lack easy access to grocery stores, farmers’ markets and other healthier food vendors, one of the larger shares among counties in the United States.

8. Seward County, Kansas
> 10 yr. change in obesity rate: +13.7 ppt
> Obesity rate: 24.9% (2004), 38.6% (2013)
> Adults who are physically inactive: 25.6%
> Median household income: $47,507

A decade ago, some 3,700 adults in Seward County were obese. Today, 5,900 are. The county is a microcosm of rising obesity rates nationwide. The U.S. obesity rate climbed from 23.2% to 27.7% over the last 10 years. Over the same period, Seward County’s obesity rate climbed even more rapidly, from 24.9% to 38.6%.

Regular exercise can help reduce the likelihood of obesity, and over the last 10 years, the share of Seward County adults living sedentary lifestyles has increased. Some 25.6% of area adults get no exercise beyond getting up and going to work, up from 24.2% a decade ago.

7. Evangeline Parish, Louisiana
> 10 yr. change in obesity rate: +14.2 ppt
> Obesity rate: 27.7% (2004), 41.9% (2013)
> Adults who are physically inactive: 33.2%
> Median household income: $30,724

Over 10,000 adults in Evangeline Parish, Louisiana are obese, up from 6,800 a decade ago. Areas with rapidly climbing obesity rates tend to be relatively low-income areas, as unhealthy, high-calorie fast food is relatively inexpensive. Many in Evangeline Parish are likely unable to afford healthier food options as the typical area household earns only $30,724 a year, well below the median household income nationwide of $55,322.

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6. Ashley County, Arkansas
> 10 yr. change in obesity rate: +14.2 ppt
> Obesity rate: 27.9% (2004), 42.1% (2013)
> Adults who are physically inactive: 34.9%
> Median household income: $36,352

Some 27.9% of adults in Ashley County, Arkansas were obese a decade ago. Today, 42.1% are. Obesity increases the risk of a number of serious diseases and conditions, including diabetes. As the county’s obesity rate has climbed, so has the diabetes diagnosis rate. Today, some 14.5% of adults in Ashley County have been diagnosed with diabetes, up from 9.2% a decade ago. The 5.3 percentage point uptick in the share of adults with diabetes in the county is far greater than the comparable change in a vast majority of counties.

5. Leslie County, Kentucky
> 10 yr. change in obesity rate: +14.3 ppt
> Obesity rate: 28.9% (2004), 43.2% (2013)
> Adults who are physically inactive: 34.3%
> Median household income: $25,282

Some 43.2% of adults in Leslie County, Kentucky are obese — one of the largest shares of any U.S. county and well above the 27.7% nationwide adult obesity rate. As is the case nationwide, obesity is a growing problem in Leslie County. As the national obesity rate rose from 23.2% a decade ago, the Leslie County obesity rate rose from 28.9%.

Counties with high obesity rates are often poor areas, and Leslie County is no exception. The typical area household earns only $25,282 a year, less than half the median income across all U.S. households of $55,322.

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4. Indiana County, Pennsylvania
> 10 yr. change in obesity rate: +14.4 ppt
> Obesity rate: 22.8% (2004), 37.2% (2013)
> Adults who are physically inactive: 28.0%
> Median household income: $45,118

As recently as a decade ago, approximately 1 in 4 adults in Indiana County, Pennsylvania were obese. Today, well over a third are dangerously overweight.

Regular exercise helps in maintaining a healthy weight, and rising obesity in Indiana County may be partly attributable to the increase in the share of county adults leading sedentary lifestyles. A decade ago, 24.4% of county adults did not engage in physical activities in their leisure time. Today, 28.0% of area adults get no exercise beyond getting up and going to work.

3. Murray County, Oklahoma
> 10 yr. change in obesity rate: +14.4 ppt
> Obesity rate: 25.3% (2004), 39.7% (2013)
> Adults who are physically inactive: 35.3%
> Median household income: $51,752

Murray is one of two counties in Oklahoma reporting a near nation-leading uptick in the adult obesity rate. As recently as 10 years ago, about 1 in 4 Murray County adults were obese. Today, nearly 40% are dangerously overweight.

The increase may be due in part to the rising incidence of unhealthy lifestyles — specifically, a declining share of adults who exercise. Some 35.3% of adults in Murray County do not exercise regularly in their leisure time, up from 32.9% a decade ago.

2. Clarendon County, South Carolina
> 10 yr. change in obesity rate: +15.2 ppt
> Obesity rate: 27.1% (2004), 42.3% (2013)
> Adults who are physically inactive: 28.6%
> Median household income: $34,106

Clarendon County, South Carolina is one of only two U.S. counties with a population of at least 10,000 to report a 10-year increase in its obesity rate of at least 15 percentage points. Over the same period, the U.S. obesity rate climbed only 4.5 percentage points. Currently, 42.3% of adults in Clarendon County are obese compared to 27.7% of American adults.

Obesity is a causal factor for diabetes — and just as the county’s obesity rate has climbed faster than typical nationwide, so has the county’s diabetes rate. While the share of adults diagnosed with diabetes nationwide climbed 2.5 percentage points to 10.0% over the past decade, the share of diagnosed diabetic adults in Clarendon County climbed 5.2 percentage points to 17.2% over the same period.

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1. Somerset County, Maryland
> 10 yr. change in obesity rate: +16.4 ppt
> Obesity rate: 25.8% (2004), 42.2% (2013)
> Adults who are physically inactive: 30.6%
> Median household income: $35,886

The share of obese adults in Somerset County, Maryland shot from 25.8% up to 42.2% over the past decade — the largest percentage point increase of any county in the United States with a population of 10,000 or more. Rising obesity rates nationwide are a major public health concern, partly because obesity increases the risk of a number of serious diseases and conditions, including diabetes. Over the same period, the share of adults diagnosed with diabetes in Somerset County climbed from 8.2% to 13.7%.

Regular physical exercise can help reduce the risk of obesity. In Somerset County, however, adults are less likely to exercise than they were a decade ago. Today, some 30.6% of area adults get no exercise beyond getting up and going to work, up from 28.9% of adults 10 years ago.

Counties Losing the Most Weight

15. Fort Bend County, Texas
> 10 yr. change in obesity rate: -1.0 ppt
> Obesity rate: 24.9% (2004), 23.9% (2013)
> Adults who are physically inactive: 20.7%
> Median household income: $91,152

Fueled in part by increasingly sedentary lifestyles and the availability of inexpensive unhealthy food options, obesity is a growing problem in the United States. Over the last 10 years, the obesity rate among American adults climbed from 23.2% to 27.7%. There are a few dozen counties nationwide bucking the trend, however. In Fort Bend County, Texas, the adult obesity rate fell by 1 percentage point — from 24.9% to 23.9% — over the past decade.

The decline in the incidence of obesity is likely partially the result of the growing number of active adults in the county. Some 23.5% of Fort Bend County adults did not engage in physical activities in their spare time a decade ago, compared to just 20.7% of the adult population today.

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14. Carver County, Minnesota
> 10 yr. change in obesity rate: -1.0 ppt
> Obesity rate: 24.0% (2004), 23.0% (2013)
> Adults who are physically inactive: 15.0%
> Median household income: $88,638

Carver County, Minnesota is one of the U.S. counties with a declining obesity rate. Only 23.0% of adults in Carver County are obese today, compared to 24.0% a decade ago. In comparison, the U.S. obesity rate climbed from 23.2% to 27.7% over the same period.

Wealthier Americans can afford a wider range of healthy options related to diet and lifestyle — and the high median income in Carver County may help explain the area’s relatively low obesity rate. The typical county household earns $88,638 a year. In comparison, the typical American household earns 55,322 annually.

13. Alameda County, California
> 10 yr. change in obesity rate: -1.0 ppt
> Obesity rate: 21.0% (2004), 20.0% (2013)
> Adults who are physically inactive: 15.8%
> Median household income: $79,831

Fewer than 40 of the roughly 2,400 U.S. counties with populations of at least 10,000 reported a declining obesity rate in the past decade — and Alameda County, California is one of them. Alameda’s obesity rate fell 1 percentage point from 21% to 20% over the past decade.

Adults with a college education often have a greater sense of control over their lives and report better health outcomes. Alameda’s falling obesity rate may be attributable in part to the county’s relatively well educated population. Some 43.9% of county adults have at least a bachelor’s degree, well above the comparable 30.3% share of adults nationwide.

12. Santa Barbara County, California
> 10 yr. change in obesity rate: -1.0 ppt
> Obesity rate: 19.2% (2004), 18.2% (2013)
> Adults who are physically inactive: 14.0%
> Median household income: $65,161

The adult obesity rate in Santa Barbara County, California fell 1 percentage point to 18.2% over the past decade. The improvement occurred during a period when the U.S. obesity rate climbed 4.5 percentage points to 27.7%. While most counties with falling obesity rates still have a lot to lose, Santa Barbara is one of only two U.S. counties with 10,000 or more people to report a near nation-leading percentage point drop in obesity where fewer than 20% of adults are obese.

Easy access to affordable, healthy food can help reduce the incidence of obesity within a given population. In Santa Barbara County, just 11% of residents have low access to food — live within one mile of a grocery store in urban areas and within 10 miles of a grocery store in rural areas — a larger share than in the vast majority of counties nationwide.

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11. Decatur County, Georgia
> 10 yr. change in obesity rate: -1.0 ppt
> Obesity rate: 31.0% (2004), 30.0% (2013)
> Adults who are physically inactive: 25.5%
> Median household income: $33,514

Adults in Decatur County, Georgia were far more likely to be obese than the typical American adult as recently as a decade ago. Some 31.0% of county adults were obese compared to 23.2% of adults nationwide. The gap in obesity rates between the county and the nation as a whole has declined considerably since — Decatur County’s obesity rate fell to 30.0%, while the U.S. obesity rate climbed to 27.7%.

The lower obesity rate in Decatur County may be attributable to healthier lifestyle choices. A decade ago, 29.4% of area adults did not get any exercise beyond getting up and going to work. Today, only 25.5% of adults in Decatur lead completely sedentary lifestyles.

10. Craig County, Oklahoma
> 10 yr. change in obesity rate: -1.0 ppt
> Obesity rate: 28.4% (2004), 27.4% (2013)
> Adults who are physically inactive: 32.7%
> Median household income: $40,036

Remaining physically active and getting regular exercise can help in maintaining a healthy weight. In Craig County, Oklahoma, adults are less likely to lead sedentary lives than they were a decade ago. Some 32.7% of county adults get no exercise beyond getting up and going to work, down from 35.8% 10 years prior.

Over the same period, the county’s obesity rate also has fallen. A decade ago, 28.4% of Craig County adults were obese, well above the 23.2% U.S. adult obesity rate at the time. Currently, 27.4% of county adults are obese, roughly in line with the nationwide share.

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9. Madison County, Mississippi
> 10 yr. change in obesity rate: -1.1 ppt
> Obesity rate: 29.7% (2004), 28.6% (2013)
> Adults who are physically inactive: 27.2%
> Median household income: $65,924

While Mississippi is often considered one of the poorest, least educated, and least healthy states, Madison County is by far the wealthiest and best educated of all state counties with populations of at least 10,000. The typical county household earns $65,924 a year, or about $25,000 more than the typical household statewide. Additionally, some 45.7% of county adults have at least a bachelor’s degree compared to 21% of adults across the state.

Higher-income individuals have access to a greater range of healthy options related to diet and lifestyle. Similarly, adults with a college education are more likely to have a greater sense of control over their lives and are more likely to be healthy. High incomes and educational attainment rates may help explain why Madison County’s obesity rate fell from 29.7% to 28.6% — one of the largest such declines in the country.

8. Sierra County, New Mexico
> 10 yr. change in obesity rate: -1.1 ppt
> Obesity rate: 22.1% (2004), 21.0% (2013)
> Adults who are physically inactive: 23.7%
> Median household income: $29,679

Many of the counties with the most rapidly declining obesity rates are far wealthier than the nation as a whole. Sierra County, New Mexico is not one of them. The typical area household earns only $29,679 a year, one of the lowest median incomes of any county in the state and the country. Many in the county may be struggling to afford adequate nutrition as some 22.1% of residents live in poverty. Poorer areas tend to rely on inexpensive, unhealthy food options such as those found at convenience stores and fast food restaurants.

What could be behind the county’s falling obesity rate may be the declining population. In the last 10 years, the share of obese Sierra County adults fell by 1.1 percentage points. Over the same period, the number of people living in the county fell by 4.6%.

7. Monroe County, Florida
> 10 yr. change in obesity rate: -1.2 ppt
> Obesity rate: 23.2% (2004), 22.0% (2013)
> Adults who are physically inactive: 20.9%
> Median household income: $60,303

Staying physically active can help maintain a healthy weight. In Monroe County, Florida, 20.9% of adults get no physical exercise, a slight improvement from the 21.9% of adults in the county leading totally sedentary lifestyles a decade prior. Healthy behaviors often yield healthy outcomes, and over the same period, the county’s obesity rate fell from 23.2% to 22.0% — bucking the national trend.

Healthy diets and lifestyles can be expensive, and the typical Monroe County household may be better able to afford a healthier lifestyle. The typical county household earns $60,303 a year, higher than the median income across the Sunshine State of $48,900.

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6. Dodge County, Georgia
> 10 yr. change in obesity rate: -1.3 ppt
> Obesity rate: 29.8% (2004), 28.5% (2013)
> Adults who are physically inactive: 28.8%
> Median household income: $35,544

The population of Dodge County, Georgia climbed by 3.4% over the past decade. While the number of obese adults also increased over the same period, it did not increase as rapidly as the population as a whole. As a result, the county’s obesity rate rate fell by 1.3 percentage points in that time, a greater improvement than in all but five other counties nationwide.

The declining obesity rate may be partially attributable to the more physically active population. The share of county adults who lead totally sedentary lifestyles fell from 31.9% to 28.8% in the past decade.

5. Alexandria, Virginia
> 10 yr. change in obesity rate: -1.4 ppt
> Obesity rate: 21.5% (2004), 20.1% (2013)
> Adults who are physically inactive: 14.7%
> Median household income: $89,200

Regular exercise can help reduce the likelihood of obesity. In the city of Alexandria, only 14.7% of adults never engage in physical activity in their leisure time, one of the smallest such shares of any U.S. county and down from 18.1% of area adults a decade ago. A growing share of adults who exercise regularly may partially explain why the share of adults who are dangerously overweight in Alexandria has fallen by 1.4 percentage points in the last decade. Only 20.1% of area adults are obese, well below the 27.7% share of American adults nationwide.

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4. Monroe County, Indiana
> 10 yr. change in obesity rate: -1.7 ppt
> Obesity rate: 23.8% (2004), 22.1% (2013)
> Adults who are physically inactive: 19.6%
> Median household income: $43,389

Only 22.1% of adults in Monroe County, Indiana are obese, a smaller share than the 27.7% adult obesity rate nationwide. A recently as 10 years ago, Monroe County was less healthy than the nation as a whole, reporting an adult obesity rate of 23.8%, which was higher than the national obesity rate of 23.2% at the time.

Access to affordable, healthy food can help reduce obesity rates across a given population. Only 15.5% of Monroe residents lack such access, a smaller share than in the majority of counties nationwide.

3. Fairfax, Virginia
> 10 yr. change in obesity rate: -2.1 ppt
> Obesity rate: 23.9% (2004), 21.8% (2013)
> Adults who are physically inactive: 16.1%
> Median household income: $104,065

Of the five counties with the most improved obesity rates over the past decade, four are in Virginia, and the city of Fairfax is one of them. The area’s adult obesity rate fell from 23.9% a decade ago to 21.8% most recently.

Obesity is a leading cause in a number of potentially deadly diseases, including diabetes. Over the same 10 year period, diabetes has also become less common in Fairfax, falling slightly from 7.9% to 7.5% — even as it climbed from 7.5% to 10.0% nationwide.

2. Prince William County, Virginia
> 10 yr. change in obesity rate: -2.2 ppt
> Obesity rate: 27.7% (2004), 25.5% (2013)
> Adults who are physically inactive: 16.9%
> Median household income: $98,546

Prince William is one of only three counties nationwide with a population of at least 10,000 to report a more than 2 percentage point drop in its adult obesity rate. As recently as 10 years ago, Prince William County had a higher obesity rate than the nation as a whole, at 27.8% compared to 23.2%, respectively. Today, about 1 in 4 county adults are obese, a lower obesity rate than the 27.7% nationwide rate.

Wealthier households have access to a broader range of healthy options related to diet and lifestyle. In Prince William County, the typical household earns nearly $100,000 a year, well above the median income nationwide of $55,322.

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1. Arlington County, Virginia
> 10 yr. change in obesity rate: -2.4 ppt
> Obesity rate: 18.5% (2004), 16.1% (2013)
> Adults who are physically inactive: 13.4%
> Median household income: $108,706

Maintaining a healthy diet is perhaps the most important behavior in maintaining a healthy weight — and easy access to healthy, affordable food is a necessary precondition to healthy eating. In Arlington County, Virginia, only 2.2% of residents lack access to such food options, nearly the smallest share of any county nationwide. Partially as a result, the county’s obesity rate of 16.1% is among the lowest nationwide and a considerable improvement from 18.5% a decade ago.

Obesity is a risk factor in a number of diseases, including diabetes. And just as obesity has become less common in Arlington County, so has diabetes. The county’s diabetes diagnosis rate fell from 5.9% to just 4.2% over the last decade. In comparison, the national diabetes diagnosis rate climbed from 7.5% to 10.0% over the same period.

Detailed Findings & Methodology

There is no single cause of obesity. Depending on the individual, causes can be hormonal, metabolic, or genetic — each of which can be difficult to measure across a broad population.

Some causal factors, however, are behavioral and quantifiable. In an interview with 24/7 Wall St., Dr. Robert H. Eckel, professor of medicine, physiology and biophysics at the University of Colorado, explained that obesity rates are closely related to “sedentary behavior and access to energy-dense foods.”

For example, a healthy diet can greatly reduce an individual’s risk of obesity. Healthy diets, however, depend on access to healthy food — access tens of millions of Americans lack.

So-called food deserts are areas without local or nearby grocery stores and farmers markets — which carry fresh fruits and vegetables at a reasonable cost. In these areas, some families are forced to rely on fast food restaurants and convenience stores for their meals. But foods at these establishments are often heavily processed and are high in fat and sugar content — each of which are known contributing factors to unhealthy weight gain.

While some fast food restaurants may offer a growing selection of healthy options, consumer behavior has not changed meaningfully. “When they go in, they are hungry, they don’t have a lot of money, and they need to feel full. And a salad just doesn’t do it,” Eckel said.

Unlike the counties with declining obesity rates, in every county with the largest increases in obesity, some share of the population lives in a food desert. In five of the counties with the largest upticks in obesity, over one-third of the population lives in a food desert.

Income is also strongly related to diet as eating well can be expensive, and higher-income households have access to a wider range of healthier food options. “Access is one thing; being able to afford it is another. Certainly lean poultry and fish and vegetables and fruits tend to have a [higher] price tag,” Eckel said.

The typical U.S. household earns $55,322 a year, and all but one of the counties with the fastest climbing obesity rates have a lower median household income than the U.S. as a whole. Conversely, 10 of the 15 counties with the largest declines in obesity have a higher than typical median household income.

In addition to a healthy diet, “regular physical activity is a tremendous strategy for preventing excess weight gain,” Eckel said. Encouragingly, only 22.3% of American adults are never physically active in their free time, down from 23.1% a decade ago. Exercise is only one component of a healthy lifestyle, however, and despite the improvement, the obesity rate continues to climb.

Still, larger shares of physically active adults may help explain the falling obesity rates in some counties on this list. In all but two counties with the largest declines in the incidence of obesity, the share of adults who exercise in their free time is larger than it was a decade prior. Meanwhile, in eight of the 15 counties with climbing obesity rates, the share of adults who exercise has fallen in the last decade.

To identify the counties gaining (and losing) the most weight, 24/7 Wall St. calculated the 10 year percentage point change in obesity rates at the county level using data from Centers for Disease Control and Prevention. We also reviewed the share of adults who do not participate in physical activity in their leisure time and the share of adults diagnosed with diabetes. All CDC data is from 2004-2013, the most recent available 10-year period. Counties with a population of less than 10,000 were excluded from the ranking. Data on food deserts comes from the U.S. Department of Agriculture’s Food Access Research Atlas. Data on total population, median household income, poverty, and educational attainment came from the U.S. Census Bureau’s 2016 American Community Survey (ACS) and are five-year estimates.

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