Most Americans’ eating habits are discouraging. Only a quarter of the population eats the recommended amount of vegetables, fruits, dairy, and healthy oils, according to the U.S. Department of Health and Human Services. In addition, most Americans are consuming above the recommended amounts of added sugar, saturated fats, and sodium — a combination that can increase the risk of serious health complications, including heart disease.

Healthy eating was at its lowest level in 2016, the latest year for which data is available, according to Gallup and Sharecare’s Community Rankings for Healthy Eating report. About 63.3% of U.S. adults reported in 2016 eating healthy all day the previous day, surpassing the previous low of 67.7% in 2010, according to a Gallup poll. Eating patterns, of course, are not the same nationwide and vary significantly from city to city. In some metro areas, the population is very health-conscious when it comes to food.

Gallup asked tens of thousands of Americans in 189 communities in all 50 states, “Did you eat healthy all day yesterday?” 24/7 Tempo reviewed the 40 metro areas with the highest share of residents reporting healthy eating.

Click here for the 40 cities with the healthiest diets

Knowledge of what qualifies as healthy food as well as income play a major role in people’s food choices, according to Dan Witters, research director for the Gallup National Health and Well-Being Index. The single most important factor, however, is having an accountability partner, he added. Other top corollaries in healthy eating include low stress levels, getting medical checkups, setting and reaching goals, and feeling optimistic about the future.

One surprising factor that makes a difference in people’s choices to eat healthy is “learning or doing something interesting every day,” Witters said. “It’s sneakily important.” Those who go through life in a mundane or intellectually lethargic manner are going to see that carry over into many aspects of their lives, including their eating choices, he noted. “It’s yet another reason why communities with a heavy academic presence or with local colleges/universities that are active in their communities do better on well-being metrics.”

Twenty of the 40 cities with the highest share of adult residents reporting eating healthy diets are in the West, 13 in the South, and seven in the Northeast. In the metro area with the healthiest diet, three-quarters of adult residents reported healthy eating. By contrast, in the metro area with the worst diet, 46.2% of adults said they eat healthy.

Income may explain some eating choices. Produce and high-quality meat tend to be more expensive than cheeseburgers and fries, which are among the unhealthiest items in every fast-food chain.

The median household income in 22 of the 40 cities with the healthiest diets is higher than the national median of $60,366 annually. “There is substantial range in wellbeing inside of every large population that is hidden when summarizing data for the overall group,” Witters said. That’s why, despite income being linked to healthy eating, there are low-income cities among the cities with the healthiest diets. In fact, the U.S. city with the lowest median household income is in the top five cities with the healthiest diets. The lowest-income metro area is “handicapped in relation to healthy eating because it is a lower-education, lower-income area,” Witters said.

Low income can contribute to poor diets, but making healthy eating decisions is possible on a budget. McAllen, Texas, one of America’s poorest cities, regularly ranks among the very best in healthy eating, according to Witters. This “provides us a good illustration of how local communities can overcome demographic handicaps.” Educational programs and community gardens are some of the ways that contribute to healthy eating, regardless of the hurdles.

In the metro areas where residents reported eating healthily, poor health outcomes are less common than in the United States as a whole. Still, nine of the 40 cities with the healthiest diets have a greater adult obesity rate than the national average.

To identify the 40 cities with the healthiest diets, 24/7 Tempo reviewed Gallup and Sharecare’s 2016 Community Rankings for Healthy Eating report. We selected the 40 metro areas — of the 189 reviewed in the report — where the highest share of adults reported eating a healthy diet all day. The share of the population living more than a mile from a grocery store also came from the report. Population and median household income data were obtained from the U.S. Census Bureau’s 2017 American Community Survey. Obesity rates came from the 2019 County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program. And these are the cities with the worst diets.