Special Report

These Are the Most Obese Counties in America

Almost half of adults in the U.S. are projected to be obese, not just overweight, by 2030, according to Harvard researchers estimates published in December 2019 in the New England Journal of Medicine. Nearly one in four people will be morbidly obese, meaning carrying about 100 pounds over one’s normal body weight.

Obesity and being overweight is the second leading cause of preventable death — after tobacco smoking — in the United States, according to the National Institutes of Health. 

Obesity is measured as a function of the body mass index, a ratio of height to weight. A person with a body mass index of 30 or greater is defined as obese. For example, a person who is 5 feet and 3 inches tall is considered obese if he or she weighs more than 169 pounds. Obesity can increase the risk of a number of serious diseases and conditions, including heart disease, type 2 diabetes, and certain types of cancer.

To determine the 40 most obese counties in the U.S., 24/7 Tempo analyzed county-level data on adult obesity rates from the 2021 County Health Rankings & Roadmaps report, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

Many of the counties with high adult obesity rates also tend to have low-income populations. People with lower incomes are less able to afford proper medical care and  healthy lifestyles, which include eating a healthy diet and having easy access to gyms and other physical activity options. Only two of the 40 counties with the highest obesity rates on this list have a median annual household income that is higher than the U.S median of $62,842.

The underlying causes of obesity are many. Some causes are within one’s control, while others, like genetics, are not. Though the reasons behind a person’s obesity are not always clear, the possible health outcomes of having obesity are clearer. One is diabetes. All but one of the most obese counties on our list have an adult diabetes rate higher than the U.S. rate of 10.5%. Click here for 10 warning signs you may have diabetes.

Obesity is also associated with a reduced quality of life, chronic conditions such as hypertension, and diseases such as heart disease and cancer that are among  the leading causes of death. Only one of the 40 counties on the list have a lower share of adults reporting being in poor or fair health than the U.S. average of 16.5%.

Health experts have pointed to several lifestyle factors that are likely contributing to the excess weight problem among Americans, among them a sedentary lifestyle and the consumption of high-calorie diets, including large sugary beverages — these are the unhealthiest items in the most popular fast-food chains in America.

Keeping active has been shown to help people maintain a healthy weight. Nationwide, 22.7% of adults report not exercising on a regular basis. Of the 40 most obese counties on our list, only two have a lower share of adults who don’t exercise regularly. 

Click here to see the most obese counties in America

To determine the 40 most obese counties in the U.S., 24/7 Tempo reviewed obesity data among adults for all 3,142 counties in the country. The obesity rates — the share of adult residents who report a body mass index of 30 or greater — came from the 2021 County Health Rankings & Roadmaps, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

The age-adjusted percentage of the total population 20 years and over diagnosed with diabetes in 2017, the latest year for which data is available, also came from the 2021 CHR. The share of adults who report being in poor or fair health is also from the 2021 CHR.

Population figures as well as median household income came from the American Community Survey 2019 5-Year Estimates.