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.
Source: Thomas R Machnitzki ([email protected]) / Wikimedia Commons
40. Haywood, Tennessee
> Obesity rate in Haywood: 47.0%
> Adults who don’t exercise: 30.9% — No. 738 out of 3,142 US counties
> Adults reporting poor or fair health: 28.7% — No. 170 out of 3,142
> Adults 20+ with diabetes: 17.7% — No. 263 out of 3,142
> Median household income: $37,905 — No. 2,844 out of 3,142
> Haywood population: 17,623
> Largest place in Haywood: Brownsville City
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38. East Carroll, Louisiana
> Obesity rate in East Carroll: 47.1%
> Adults who don’t exercise: 19.8% — No. 2,774 out of 3,142 US counties
> Adults reporting poor or fair health: 40.5% — No. 03 out of 3,142
> Adults 20+ with diabetes: 22.1% — No. 45 out of 3,142
> Median household income: $22,346 — No. 3,139 out of 3,142
> East Carroll population: 7,096
> Largest place in East Carroll: Lake Providence Town
Source: Sturmgewehr88 / Wikimedia Commons
38. Greene, Mississippi
> Obesity rate in Greene: 47.1%
> Adults who don’t exercise: 30.2% — No. 841 out of 3,142 US counties
> Adults reporting poor or fair health: 22.7% — No. 932 out of 3,142
> Adults 20+ with diabetes: 14.0% — No. 898 out of 3,142
> Median household income: $49,677 — No. 1,818 out of 3,142
> Greene population: 13,645
> Largest place in Greene: Leakesville Town
Source: BOB WESTON / iStock via Getty Images
36. Choctaw, Alabama
> Obesity rate in Choctaw: 47.2%
> Adults who don’t exercise: 33.7% — No. 364 out of 3,142 US counties
> Adults reporting poor or fair health: 26.4% — No. 390 out of 3,142
> Adults 20+ with diabetes: 17.9% — No. 240 out of 3,142
> Median household income: $35,892 — No. 2,946 out of 3,142
> Choctaw population: 12,925
> Largest place in Choctaw: Butler Town
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Source: Public Domain / Wikimedia Commons
36. Thurston, Nebraska
> Obesity rate in Thurston: 47.2%
> Adults who don’t exercise: 29.2% — No. 1,008 out of 3,142 US counties
> Adults reporting poor or fair health: 23.5% — No. 791 out of 3,142
> Adults 20+ with diabetes: 18.8% — No. 169 out of 3,142
> Median household income: $51,034 — No. 1,649 out of 3,142
> Thurston population: 7,181
> Largest place in Thurston: Pender Village
Source: C5Media / iStock Editorial via Getty Images
32. Claiborne, Mississippi
> Obesity rate in Claiborne: 47.4%
> Adults who don’t exercise: 38.7% — No. 72 out of 3,142 US counties
> Adults reporting poor or fair health: 35.8% — No. 21 out of 3,142
> Adults 20+ with diabetes: 18.6% — No. 187 out of 3,142
> Median household income: $29,338 — No. 3,100 out of 3,142
> Claiborne population: 9,089
> Largest place in Claiborne: Port Gibson City
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Source: Thomas R Machnitzki / Wikimedia Commons
32. Lauderdale, Tennessee
> Obesity rate in Lauderdale: 47.4%
> Adults who don’t exercise: 36.0% — No. 193 out of 3,142 US counties
> Adults reporting poor or fair health: 30.2% — No. 104 out of 3,142
> Adults 20+ with diabetes: 21.5% — No. 58 out of 3,142
> Median household income: $39,896 — No. 2,720 out of 3,142
> Lauderdale population: 25,989
> Largest place in Lauderdale: Ripley City
32. Johnson, Georgia
> Obesity rate in Johnson: 47.4%
> Adults who don’t exercise: 38.4% — No. 79 out of 3,142 US counties
> Adults reporting poor or fair health: 25.4% — No. 511 out of 3,142
> Adults 20+ with diabetes: 22.4% — No. 40 out of 3,142
> Median household income: $42,446 — No. 2,510 out of 3,142
> Johnson population: 9,691
> Largest place in Johnson: Wrightsville City
Source: andrewbain / Flickr
32. Southampton, Virginia
> Obesity rate in Southampton: 47.4%
> Adults who don’t exercise: 33.6% — No. 376 out of 3,142 US counties
> Adults reporting poor or fair health: 20.3% — No. 1,397 out of 3,142
> Adults 20+ with diabetes: 16.3% — No. 434 out of 3,142
> Median household income: $61,348 — No. 674 out of 3,142
> Southampton population: 17,880
> Largest place in Southampton: Courtland Town
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Source: formulaone / Flickr
30. Desha, Arkansas
> Obesity rate in Desha: 47.5%
> Adults who don’t exercise: 34.8% — No. 273 out of 3,142 US counties
> Adults reporting poor or fair health: 33.4% — No. 42 out of 3,142
> Adults 20+ with diabetes: 9.5% — No. 2,398 out of 3,142
> Median household income: $31,893 — No. 3,056 out of 3,142
> Desha population: 11,709
> Largest place in Desha: Dumas City
30. St. John the Baptist, Louisiana
> Obesity rate in St. John the Baptist: 47.5%
> Adults who don’t exercise: 32.4% — No. 524 out of 3,142 US counties
> Adults reporting poor or fair health: 23.4% — No. 817 out of 3,142
> Adults 20+ with diabetes: 12.3% — No. 1,397 out of 3,142
> Median household income: $57,429 — No. 971 out of 3,142
> St. John the Baptist population: 43,242
> Largest place in St. John the Baptist: Laplace CDP
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Source: BOB WESTON / iStock via Getty Images
29. Wayne, Mississippi
> Obesity rate in Wayne: 47.9%
> Adults who don’t exercise: 39.5% — No. 52 out of 3,142 US counties
> Adults reporting poor or fair health: 26.5% — No. 373 out of 3,142
> Adults 20+ with diabetes: 23.4% — No. 21 out of 3,142
> Median household income: $37,706 — No. 2,855 out of 3,142
> Wayne population: 20,373
> Largest place in Wayne: Waynesboro City
Source: nataliemaynor / Flickr
27. Jasper, Mississippi
> Obesity rate in Jasper: 48.1%
> Adults who don’t exercise: 33.0% — No. 442 out of 3,142 US counties
> Adults reporting poor or fair health: 27.1% — No. 305 out of 3,142
> Adults 20+ with diabetes: 20.9% — No. 75 out of 3,142
> Median household income: $35,872 — No. 2,949 out of 3,142
> Jasper population: 16,505
> Largest place in Jasper: Bay Springs City
Source: Billwhittaker / Wikimedia Commons
27. Franklin, Iowa
> Obesity rate in Franklin: 48.1%
> Adults who don’t exercise: 28.1% — No. 1,218 out of 3,142 US counties
> Adults reporting poor or fair health: 16.3% — No. 2,327 out of 3,142
> Adults 20+ with diabetes: 15.8% — No. 502 out of 3,142
> Median household income: $56,419 — No. 1,063 out of 3,142
> Franklin population: 10,162
> Largest place in Franklin: Hampton City
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Source: sshepard / iStock via Getty Images
26. St. Francis, Arkansas
> Obesity rate in St. Francis: 48.2%
> Adults who don’t exercise: 31.0% — No. 718 out of 3,142 US counties
> Adults reporting poor or fair health: 31.4% — No. 69 out of 3,142
> Adults 20+ with diabetes: 15.4% — No. 575 out of 3,142
> Median household income: $35,348 — No. 2,965 out of 3,142
> St. Francis population: 25,900
> Largest place in St. Francis: Forrest City City
Source: Indy beetle / Wikimedia Commons
25. Hertford, North Carolina
> Obesity rate in Hertford: 48.5%
> Adults who don’t exercise: 41.7% — No. 19 out of 3,142 US counties
> Adults reporting poor or fair health: 26.9% — No. 325 out of 3,142
> Adults 20+ with diabetes: 25.2% — No. 10 out of 3,142
> Median household income: $41,028 — No. 2,631 out of 3,142
> Hertford population: 24,012
> Largest place in Hertford: Ahoskie Town
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Source: Scott Romine / Wikimedia Commons
24. Wayne, Iowa
> Obesity rate in Wayne: 48.6%
> Adults who don’t exercise: 27.8% — No. 1,270 out of 3,142 US counties
> Adults reporting poor or fair health: 17.7% — No. 2,015 out of 3,142
> Adults 20+ with diabetes: 20.3% — No. 93 out of 3,142
> Median household income: $44,768 — No. 2,298 out of 3,142
> Wayne population: 6,429
> Largest place in Wayne: Corydon City
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Source: Jennifer Blount / iStock via Getty Images
23. King and Queen, Virginia
> Obesity rate in King and Queen: 48.7%
> Adults who don’t exercise: 32.2% — No. 551 out of 3,142 US counties
> Adults reporting poor or fair health: 21.4% — No. 1,173 out of 3,142
> Adults 20+ with diabetes: 17.7% — No. 263 out of 3,142
> Median household income: $63,982 — No. 526 out of 3,142
> King and Queen population: 7,042
> Largest place in King and Queen: N/A .
Source: Indy beetle / Wikimedia Commons
22. Gates, North Carolina
> Obesity rate in Gates: 48.9%
> Adults who don’t exercise: 35.8% — No. 207 out of 3,142 US counties
> Adults reporting poor or fair health: 19.5% — No. 1,584 out of 3,142
> Adults 20+ with diabetes: 15.8% — No. 502 out of 3,142
> Median household income: $50,750 — No. 1,673 out of 3,142
> Gates population: 11,548
> Largest place in Gates: Gatesville Town
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21. Bladen, North Carolina
> Obesity rate in Bladen: 49.1%
> Adults who don’t exercise: 30.7% — No. 773 out of 3,142 US counties
> Adults reporting poor or fair health: 26.2% — No. 407 out of 3,142
> Adults 20+ with diabetes: 22.3% — No. 41 out of 3,142
> Median household income: $36,173 — No. 2,931 out of 3,142
> Bladen population: 33,407
> Largest place in Bladen: Elizabethtown Town
Source: BOB WESTON / iStock via Getty Images
20. Leake, Mississippi
> Obesity rate in Leake: 49.2%
> Adults who don’t exercise: 35.2% — No. 242 out of 3,142 US counties
> Adults reporting poor or fair health: 29.6% — No. 126 out of 3,142
> Adults 20+ with diabetes: 21.9% — No. 51 out of 3,142
> Median household income: $37,096 — No. 2,897 out of 3,142
> Leake population: 22,792
> Largest place in Leake: Carthage City
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19. Wilkinson, Mississippi
> Obesity rate in Wilkinson: 49.4%
> Adults who don’t exercise: 34.2% — No. 325 out of 3,142 US counties
> Adults reporting poor or fair health: 36.1% — No. 15 out of 3,142
> Adults 20+ with diabetes: 11.9% — No. 1,537 out of 3,142
> Median household income: $27,313 — No. 3,117 out of 3,142
> Wilkinson population: 8,875
> Largest place in Wilkinson: Centreville Town
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Source: Upstateherd / Wikimedia Commons
18. Warren, Georgia
> Obesity rate in Warren: 49.5%
> Adults who don’t exercise: 21.8% — No. 2,502 out of 3,142 US counties
> Adults reporting poor or fair health: 28.3% — No. 193 out of 3,142
> Adults 20+ with diabetes: 21.7% — No. 55 out of 3,142
> Median household income: $37,203 — No. 2,891 out of 3,142
> Warren population: 5,297
> Largest place in Warren: Warrenton City
15. Wilcox, Alabama
> Obesity rate in Wilcox: 49.8%
> Adults who don’t exercise: 34.6% — No. 294 out of 3,142 US counties
> Adults reporting poor or fair health: 32.1% — No. 57 out of 3,142
> Adults 20+ with diabetes: 18.7% — No. 177 out of 3,142
> Median household income: $31,014 — No. 3,069 out of 3,142
> Wilcox population: 10,681
> Largest place in Wilcox: Camden City
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Source: BOB WESTON / iStock via Getty Images
15. Noxubee, Mississippi
> Obesity rate in Noxubee: 49.8%
> Adults who don’t exercise: 31.6% — No. 632 out of 3,142 US counties
> Adults reporting poor or fair health: 30.5% — No. 94 out of 3,142
> Adults 20+ with diabetes: 12.6% — No. 1,307 out of 3,142
> Median household income: $33,784 — No. 3,012 out of 3,142
> Noxubee population: 10,700
> Largest place in Noxubee: Macon City
15. Scott, Mississippi
> Obesity rate in Scott: 49.8%
> Adults who don’t exercise: 32.6% — No. 501 out of 3,142 US counties
> Adults reporting poor or fair health: 30.5% — No. 98 out of 3,142
> Adults 20+ with diabetes: 24.3% — No. 13 out of 3,142
> Median household income: $34,943 — No. 2,976 out of 3,142
> Scott population: 28,332
> Largest place in Scott: Forest City
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Source: keepphotos / Getty Images
14. Clay, Mississippi
> Obesity rate in Clay: 50.2%
> Adults who don’t exercise: 31.9% — No. 585 out of 3,142 US counties
> Adults reporting poor or fair health: 26.6% — No. 359 out of 3,142
> Adults 20+ with diabetes: 17.0% — No. 338 out of 3,142
> Median household income: $31,833 — No. 3,058 out of 3,142
> Clay population: 19,640
> Largest place in Clay: West Point City
Source: BOB WESTON / iStock via Getty Images
13. Troup, Georgia
> Obesity rate in Troup: 50.3%
> Adults who don’t exercise: 31.3% — No. 673 out of 3,142 US counties
> Adults reporting poor or fair health: 22.0% — No. 1,054 out of 3,142
> Adults 20+ with diabetes: 12.6% — No. 1,307 out of 3,142
> Median household income: $45,649 — No. 2,222 out of 3,142
> Troup population: 69,919
> Largest place in Troup: LaGrange City
Source: Harry Weddington, U.S. Army Corps of Engineers / Wikimedia Commons
12. Buffalo, South Dakota
> Obesity rate in Buffalo: 50.4%
> Adults who don’t exercise: 27.2% — No. 1,396 out of 3,142 US counties
> Adults reporting poor or fair health: 34.6% — No. 32 out of 3,142
> Adults 20+ with diabetes: 18.4% — No. 207 out of 3,142
> Median household income: $34,808 — No. 2,983 out of 3,142
> Buffalo population: 2,026
> Largest place in Buffalo: Fort Thompson CDP
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Source: BOB WESTON / iStock via Getty Images
11. Simpson, Mississippi
> Obesity rate in Simpson: 50.6%
> Adults who don’t exercise: 31.9% — No. 585 out of 3,142 US counties
> Adults reporting poor or fair health: 27.2% — No. 290 out of 3,142
> Adults 20+ with diabetes: 18.1% — No. 230 out of 3,142
> Median household income: $43,850 — No. 2,386 out of 3,142
> Simpson population: 26,888
> Largest place in Simpson: Magee City
Source: BOB WESTON / iStock via Getty Images
10. Holmes, Mississippi
> Obesity rate in Holmes: 50.7%
> Adults who don’t exercise: 40.7% — No. 32 out of 3,142 US counties
> Adults reporting poor or fair health: 37.0% — No. 11 out of 3,142
> Adults 20+ with diabetes: 20.5% — No. 85 out of 3,142
> Median household income: $21,504 — No. 3,141 out of 3,142
> Holmes population: 17,737
> Largest place in Holmes: Durant City
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9. Sabine, Louisiana
> Obesity rate in Sabine: 50.8%
> Adults who don’t exercise: 33.2% — No. 421 out of 3,142 US counties
> Adults reporting poor or fair health: 23.9% — No. 733 out of 3,142
> Adults 20+ with diabetes: 15.4% — No. 575 out of 3,142
> Median household income: $40,336 — No. 2,684 out of 3,142
> Sabine population: 23,991
> Largest place in Sabine: Many Town
7. Jefferson, Mississippi
> Obesity rate in Jefferson: 50.9%
> Adults who don’t exercise: 36.3% — No. 179 out of 3,142 US counties
> Adults reporting poor or fair health: 37.9% — No. 08 out of 3,142
> Adults 20+ with diabetes: 16.7% — No. 378 out of 3,142
> Median household income: $25,019 — No. 3,131 out of 3,142
> Jefferson population: 7,225
> Largest place in Jefferson: Fayette City
Source: Rivers Langley; SaveRivers / Wikimedia Commons
7. Macon, Alabama
> Obesity rate in Macon: 50.9%
> Adults who don’t exercise: 32.5% — No. 515 out of 3,142 US counties
> Adults reporting poor or fair health: 28.0% — No. 215 out of 3,142
> Adults 20+ with diabetes: 16.8% — No. 371 out of 3,142
> Median household income: $33,370 — No. 3,021 out of 3,142
> Macon population: 18,708
> Largest place in Macon: Tuskegee City
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Source: Public Domain / Wikimedia Commons
6. Aleutians East, Alaska
> Obesity rate in Aleutians East: 51.9%
> Adults who don’t exercise: 26.6% — No. 1,521 out of 3,142 US counties
> Adults reporting poor or fair health: 20.9% — No. 1,282 out of 3,142
> Adults 20+ with diabetes: 14.5% — No. 789 out of 3,142
> Median household income: $69,250 — No. 338 out of 3,142
> Aleutians East population: 3,385
> Largest place in Aleutians East: Sand Point City
Source: Jeff the quiet / Public Domain / Wikimedia Commons
5. Ziebach, South Dakota
> Obesity rate in Ziebach: 52.5%
> Adults who don’t exercise: 27.2% — No. 1,396 out of 3,142 US counties
> Adults reporting poor or fair health: 30.5% — No. 96 out of 3,142
> Adults 20+ with diabetes: 19.0% — No. 151 out of 3,142
> Median household income: $37,400 — No. 2,876 out of 3,142
> Ziebach population: 2,791
> Largest place in Ziebach: Eagle Butte City
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Source: C5Media / iStock Editorial via Getty Images
4. Humphreys, Mississippi
> Obesity rate in Humphreys: 53.2%
> Adults who don’t exercise: 28.5% — No. 1,134 out of 3,142 US counties
> Adults reporting poor or fair health: 36.3% — No. 14 out of 3,142
> Adults 20+ with diabetes: 15.8% — No. 502 out of 3,142
> Median household income: $28,962 — No. 3,105 out of 3,142
> Humphreys population: 8,389
> Largest place in Humphreys: Belzoni City
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Source: csfotoimages / iStock Editorial via Getty Images
2. Sunflower, Mississippi
> Obesity rate in Sunflower: 53.7%
> Adults who don’t exercise: 31.0% — No. 718 out of 3,142 US counties
> Adults reporting poor or fair health: 32.4% — No. 53 out of 3,142
> Adults 20+ with diabetes: 24.6% — No. 12 out of 3,142
> Median household income: $30,838 — No. 3,074 out of 3,142
> Sunflower population: 26,168
> Largest place in Sunflower: Indianola City
Source: Richardelainechambers at English Wikipedia / Wikimedia Commons
2. Candler, Georgia
> Obesity rate in Candler: 53.7%
> Adults who don’t exercise: 28.1% — No. 1,218 out of 3,142 US counties
> Adults reporting poor or fair health: 28.1% — No. 206 out of 3,142
> Adults 20+ with diabetes: 15.4% — No. 575 out of 3,142
> Median household income: $33,736 — No. 3,014 out of 3,142
> Candler population: 10,812
> Largest place in Candler: Metter City
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Source: Pigdogx / Wikimedia Commons
1. Okfuskee, Oklahoma
> Obesity rate in Okfuskee: 58.9%
> Adults who don’t exercise: 42.4% — No. 15 out of 3,142 US counties
> Adults reporting poor or fair health: 28.5% — No. 184 out of 3,142
> Adults 20+ with diabetes: 15.3% — No. 601 out of 3,142
> Median household income: $38,411 — No. 2,808 out of 3,142
> Okfuskee population: 12,067
> Largest place in Okfuskee: Okemah City
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