Detailed Findings & Methodology
Eating a well-balanced diet with ample servings of fruits and vegetables can result in better overall health. Indeed, states with the largest shares of residents reporting balanced diets tend to have a lower prevalence of adult obesity. Of the 25 states with the highest share of adults and adolescents eating fruits and vegetables at least once daily, the adult obesity rate exceeds the national rate of 28.9% in only eight.
Conversely, the states with the poorest diets tend to have much higher obesity rates. The adult obesity rate in 22 of the 25 states with the least healthy dietary habits — as measured by regular fruit and vegetable consumption — topped the national obesity rate of 28.9%.
Obesity is only one, relatively specific health outcome related to diet. In an interview with 24/7 Wall St., Kate Konkle, associate researcher with County Health Rankings and Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program, explained that broadly speaking health outcomes should be thought of in terms of both length and quality of life. “What you’re putting in your body impacts both of those things,” Konkle said.
Perhaps not surprisingly, states with large shares of residents reporting healthy dietary habits tend to report better health outcomes overall. Each of the 10 states with the highest fruit and vegetable consumption rates have a lower premature death rate than the U.S. rate of 333 deaths before age 75 per 100,000 residents. Additionally, eight of the 10 states with the best diets are home to a smaller share of adults who report being in sub-optimal health than the 15.0% national average.
Several factors can help explain dietary habits across broad populations. First and foremost, healthy, well balanced diets can be prohibitively expensive for many Americans. “If you’re spending a lot of money on rent, you might not have enough money left over to buy the fruits and vegetables,” Konkle said.
Perhaps not surprisingly, states with the healthiest diets tend to be higher earning. Of the 10 states ranking highest on this list, eight have a higher median household income than the $57,617 the typical American household earns. Similarly, each of the 10 states with the worst dietary habits have a lower than typical median household income.
The importance of income to maintaining a healthy diet is highlighted by the food insecurity rate — or the share of households that struggled to afford varied diets or food in general in the last year. About 13.0% of American households were considered food insecure in between 2014 and 2016, as reported by the United States Department of Agriculture. All 10 states with the worst diets have a higher food insecurity rate than the U.S. as a whole.
A large share of residents reporting daily fruit and vegetable consumption does not necessarily mean a population has healthy diets overall. Not only does fruit and vegetable consumption not account for potential over-consumption of sweets and fatty foods, but even fruits and vegetables can be unhealthy — depending on how they are prepared. “You can certainly take a healthy food and make it unhealthy pretty quickly if you fry it or put a lot of butter or cheese on it,” Konkle said.
Still, relatively widespread healthy eating habits can be indicative of an overly health conscious population. For many, maintaining a balanced diet is only one piece of a healthy lifestyle. Regular exercise is another. Adults are more likely to engage in physical activity in their free time in nine of the 10 states with the best diets. Meanwhile, in each of the 10 states where adults are least likely to report a balanced diet, adults are less likely to report a physically active lifestyle.
To identify the states with the best and worst diets, 24/7 Wall St. created an index from the Nutrition, Physical Activity, and Obesity – Behavioral Risk Factor Surveillance System databases for adults and youth between ninth and 12th grade from the Centers for Disease Control and Prevention (CDC) for 2016 (adults) and 2015 (youth), the most recent data available. Index values include the percentage of adults and youth who consume fruit and vegetables at least once daily, and the percentage of youth who drink regular soda / pop at least once daily. For those states that were missing one or more index values, the data that was available was weighed heavier in the calculation of the composite index. Median household income, poverty, the uninsured population, and bachelor’s degree attainment rates came from the U.S Census Bureau’s American Community Survey (ACS) and are for 2016. Obesity rate, percent of adults reporting fair or poor health, and the premature age-adjusted mortality rate per 100,000 people for each state came from the the 2017 County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program. Percent of the population with low or very low food security came from the USDA State-Level Prevalence of Food Insecurity for 2014-2016.