Every single state in the bottom ten for adult obesity rates is a Republican-controlled state that voted for Donald Trump in 2024. Not nine. Not eight. All ten. Some are deep-red strongholds that haven’t sent a Democrat to the White House since the 1970s. Several have governors who have publicly partnered with Health Secretary Robert F. Kennedy Jr. to advance MAHA legislation at the state level. The data, drawn from the CDC’s Behavioral Risk Factor Surveillance System, puts obesity rates in these states between 37.2% and 41.4%. The gap between the worst-performing states and the national average represents millions of people.
The following is a state-by-state account of where those numbers come from, what drives them, and why the MAHA agenda faces its steepest climb precisely where its political base is deepest.
Executive Summary
The CDC’s 2024 Adult Obesity Prevalence Maps, covering 49 states, the District of Columbia, and three U.S. territories, are based on self-reported weight and height data from the Behavioral Risk Factor Surveillance System and were updated December 3, 2025. Two states, Mississippi and West Virginia, along with Guam, recorded adult obesity rates of 40% or higher. Overall, the Midwest (35.9%) and South (34.5%) reported the highest regional obesity prevalence, followed by the West (30.2%) and the Northeast (30.3%).
Promoted by HHS Secretary Robert F. Kennedy Jr., the MAHA agenda has made its deepest inroads at the state level, with strong support from Republicans. The $50 billion Rural Health Transformation Program, created as part of the GOP’s One Big Beautiful Bill Act, offers incentives to states that implement MAHA policies. Yet the states with the worst obesity outcomes in the country are, without exception, the states most enthusiastic about MAHA, a tension the movement has yet to address directly.
The 10 States With the Highest Obesity Rates in America
1. West Virginia: 41.4%
West Virginia tops the national list, with 41.4% of adults classified as obese. CDC 2022 state life tables show West Virginia has the lowest life expectancy of any state at 72.2 years. High poverty rates, a lack of infrastructure for physical activity, and the cost of fresh produce and healthy groceries are the primary drivers. Mississippi ranks highest nationally for physical inactivity among adults, while West Virginia also records one of the country’s highest shares of adults reporting no physical activity outside of work.
Despite those numbers, West Virginia has been one of the most aggressive states in adopting MAHA-aligned legislation. A landmark bill signed into law in March 2025 banned most artificial dyes and two preservatives from sale in the state starting in 2028, highlighting how concern over the safety of the U.S. food supply has become an increasingly nonpartisan issue. Removing Red No. 40 from school lunches is not a trivial act, but it is unlikely to move an obesity rate that is rooted in poverty, rural geography, and decades of economic decline in the post-coal era.
2. Mississippi: 40.4%
Based on 2024 CDC Behavioral Risk Factor Surveillance System data, Mississippi records an adult obesity rate of 40.4%. Data from 2019 to 2023 consistently ranked Mississippi 51st out of 51 jurisdictions, reflecting the worst-performing healthcare system for any state in the country. Mississippi is also among the states that have not expanded Medicaid eligibility under the Affordable Care Act, leaving hundreds of thousands of low-income adults without affordable coverage and without meaningful access to obesity prevention or treatment services.
The food access picture is equally stark. Mississippi’s obesity rate is deeply tied to a food culture centered on meals high in calories, fat, and sugar, and the state faces significant challenges with food deserts, where healthy options are scarce. Lower income is the dominant factor in an American’s increased likelihood to be obese, and Mississippi is the poorest state in the nation by most measures, a fact no food dye ban addresses directly. Mississippi also ranks first nationally for physical inactivity, with 2024 data showing it has the highest share of adults reporting no exercise outside of work among all 50 states.
3. Louisiana: 39.2%
Louisiana ranks third nationwide, with 39.2% of adults living with obesity in 2024, based on CDC Behavioral Risk Factor Surveillance System data. The state also has elevated rates of type 2 diabetes and cardiovascular disease, and county-level data reveal higher obesity prevalence in rural parishes, where residents face longer travel distances to primary care and limited access to full-service grocery stores.
Louisiana’s culinary identity, rooted in rich, calorie-dense Creole and Cajun traditions, is a genuine contributing factor, though one that interacts with poverty and food access rather than operating independently of them. Federal food-access mapping identifies multiple low-access areas across the Delta and northern parishes. Louisiana’s Governor Jeff Landry has partnered publicly with RFK Jr. on food transparency legislation, making the state something of a MAHA showcase, even as it holds the third-highest adult obesity rate in the country.
4. Alabama: 38.9%
Alabama records an adult obesity rate of 38.9% according to CDC 2024 BRFSS data. The drivers are familiar across this list: high poverty, sedentary lifestyles, and diet patterns that reflect both cultural tradition and economic constraint. Alabama is among the ten states that have not expanded Medicaid, a policy decision that directly limits access to preventive care and weight management services for its lowest-income residents. Alabama has voted Republican in every presidential election since 1980, and its political alignment has not translated into health outcomes that match its partisan energy around MAHA.
5. Arkansas: 38.9%
In Arkansas, high poverty levels restrict access to healthy food and opportunities for physical activity. The state has fewer venues for exercise, and residents face challenges accessing affordable nutritious food. As a result, many people rely on cheap, calorie-dense options, which significantly contribute to the state’s high obesity rate.
Arkansas has moved to implement MAHA-adjacent reforms. “Since MAHA has come up as a political force, you see a lot of state legislators in red states that all of a sudden are all excited about food and health and nutrition and additives,” said Susan Schneider, a University of Arkansas law professor. The enthusiasm is real. Whether it translates into structural change for residents who cannot afford fresh groceries remains the unresolved question.
6. Indiana: 38.4%
Indiana records an adult obesity rate of 38.4%, placing it sixth nationally. Indiana’s obesity burden follows the pattern seen across the Midwest and South: a combination of rural geography, food access constraints, high rates of sedentary employment, and poverty concentrated in both rural counties and mid-sized cities. The state has expanded Medicaid, which distinguishes it from several of its peer states on this list, but expansion alone has not been sufficient to move the obesity needle in a state where structural conditions, including a manufacturing economy that has shed physical labor jobs over decades, continue to shape health outcomes.
7. Kansas: 37.6%
Kansas records a 37.6% adult obesity rate. County-level CDC maps show higher obesity rates in central and western Kansas, where populations are more rural, and USDA food-access data indicate many of those counties have limited proximity to full-service grocery stores. Adults living in rural areas have had higher obesity rates than their urban counterparts since 2016, a trend that continued through 2024 even as urban obesity rates declined. Kansas is deeply Republican, and its rural obesity rates reflect a national trend that no single state administration, regardless of its political alignment, has yet managed to reverse.
8. Nebraska: 37.6%
State health data show adult hypertension affects roughly one in three Nebraskans and diabetes prevalence exceeds 10%, both conditions strongly associated with obesity. County-level CDC maps identify higher obesity rates in central and western Nebraska, where populations are more rural. USDA Food Access Research Atlas data show the rural obesity rate rose from 47.8% to 48.3% between 2022-2023 and 2023-2024, a reminder that rural America, which dominates the geography of states like Nebraska, is moving in the wrong direction even as some urban areas show modest improvement. Nebraska is a reliably Republican state, though it splits its electoral votes by congressional district, a distinction that does nothing to alter its public health standing.
9. Kentucky: 37.2%
According to America’s Health Rankings, a high concentration of fast-food outlets paired with lower educational attainment and socioeconomic barriers that restrict safe spaces for physical activity are key contributing factors to Kentucky’s 37.2% adult obesity rate. Kentucky has expanded Medicaid and has actually seen coverage gains as a result, but expanded insurance access does not automatically translate into reduced obesity rates when the underlying conditions of poverty and food access remain unchanged. Kentucky has voted Republican in the last five presidential elections.
10. Wisconsin: 37.4% (Tied)
Wisconsin appears in the CDC’s list of states with an adult obesity rate of 35% or higher, and CDC BRFSS 2024 data place it at 37.4%, tying with Kansas and Nebraska at the lower end of the top ten. Wisconsin is less stereotypically Southern than the other states on this list, which makes its presence here instructive. Its obesity burden is concentrated in its rural counties and former manufacturing communities, where economic decline has created conditions (stress, sedentary work, processed food dependence) that function identically to the structural drivers seen in Mississippi and West Virginia, just at a lower absolute level.
What These States Have in Common
The geographic concentration of obesity rates red states reveal is not coincidental. These regions have historically faced higher poverty rates, limited healthcare access, and lower levels of physical activity. Diet patterns and food accessibility also play a role, particularly in rural communities where the nearest full-service grocery store can be ten miles away or more.
Rising obesity rates are closely tied to increased healthcare costs and higher risks of conditions like diabetes, heart disease, and certain cancers. The Commonwealth Fund’s 2025 State Health System Scorecard documents the systemic failures clearly: ten states have not expanded Medicaid eligibility, including Alabama, Mississippi, Tennessee, Kansas, and others that appear near the top of the obesity rankings. That decision alone creates a structural gap in access to preventive care, including obesity counseling, metabolic screenings, and weight management programs, that cannot be papered over with food dye legislation.
Before 2013, no state in the country had an adult obesity prevalence at or above 35%. Now, in 23 states, more than one in three adults meets the clinical definition of obesity. The acceleration has happened during a period in which both Republican and Democratic administrations have been in power at the federal level, which tells you something important: the forces driving this trend are not primarily ideological. They are economic, geographic, and structural. But the states that have done the least to counteract those forces through Medicaid expansion, food access investment, and public health infrastructure are, almost without exception, the states that have leaned hardest into the politics of individual responsibility over systemic intervention.
For a closer look at how food environments shape long-term health outcomes across vulnerable communities, read our coverage of food access and chronic illness.
The MAHA Paradox
Lawmakers across the country introduced more than 100 bills and enacted at least 11 laws in 2026 to regulate food additives, school meals, and low-income food assistance. In doing so, state legislatures aren’t only aligning with the MAHA movement, they’re getting ahead of it. Forty percent of the U.S. food and beverage industry has committed to removing artificial dyes from their products, and HHS has redirected $1.8 billion per year to combat the childhood chronic disease epidemic.
These are not nothing. Removing artificial dyes from school food is a legitimate public health measure. Restricting SNAP purchases of ultra-processed products could shift buying patterns at the margins. But researchers writing in a 2025 study published in the Hastings Center Report concluded that the MAHA Commission “appears to be both ideologically driven and scientifically unsound,” with exceedingly low prospects of proposing policies that meaningfully address chronic disease.
The harder structural question, which the administration has not yet answered, is why the states most enthusiastic about MAHA are also the states where the crisis is worst and whether the policy tools being prioritized are capable of reaching the people who need help most.
Key Takeaways
The ten states with the highest adult obesity rates in the United States are all Republican-controlled, all voted for Donald Trump in 2024, and several have been among the most vocal supporters of the MAHA initiative. That alignment is not a partisan talking point, it is a public health data point, drawn from the CDC’s own surveillance system, that has significant implications for how the administration’s health agenda should be evaluated.
The common denominators across these ten states are poverty, rural geography, inadequate healthcare access, and food environments that make unhealthy eating cheaper and easier than the alternative. Several of these states have declined to expand Medicaid, which would extend access to preventive services to their lowest-income residents, the very population most affected by obesity. Food dye bans and SNAP restrictions may be politically resonant, but they operate at the surface of a problem whose roots run considerably deeper.
As Karen Hacker, former director of CDC’s National Center for Chronic Disease Prevention and Health Promotion, stated: “Obesity prevention at young ages is critical, because we know that children with obesity often become adults with obesity.” That observation points toward the long timeline of this crisis. The adults showing up in these 2024 statistics grew up in the same states, with the same food environments and the same structural disadvantages that persist today. Changing those numbers meaningfully requires infrastructure investment, coverage expansion, and sustained economic development, the kind that takes decades, not a single legislative session.
The MAHA movement deserves credit for putting chronic disease on the national agenda. What the obesity data demands is that the conversation move from food labels to the structural conditions that make unhealthy eating not a choice, but a constraint.
What the Numbers Don’t Say About Themselves
Data like this tends to get picked up fast and dropped just as quickly, shared as a partisan score, filed under “told you so,” and forgotten by the next news cycle. That would be a waste. Because the more unsettling truth here is that none of this is new. These same states have occupied the bottom of national health rankings for decades, under governors and legislators of both parties, through boom years and recessions alike. The obesity crisis in West Virginia and Mississippi did not begin with MAHA and will not end with it.
What the MAHA movement has done is create an opening, a moment where chronic disease is on the front page, where food quality is being debated in state legislatures that once ignored it, and where some version of the conversation about why Americans are so sick is finally happening in public. That is not nothing. The problem is that the structural answers to these numbers (Medicaid expansion, rural infrastructure investment, addressing the poverty that makes processed food the only affordable option) are precisely the interventions the current political coalition is least positioned to make. Banning Red No. 40 from a school cafeteria in West Virginia is easier than rebuilding the economic conditions that made West Virginia the unhealthiest state in America. Both things can be true: the food dye conversation matters, and it is nowhere near enough.
Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment and is for information only. Always seek the advice of your physician or another qualified health provider with any questions about your medical condition and/or current medication. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.