But a new report from Trust for America’s Health and Robert Wood Johnson Foundation breaks down the most recently available obesity statistics, based on Centers for Disease Control (CDC) data, on a state-wide, and sobering, basis, finding that seven U.S. states have adult obesity rates that exceed 35%.

“[N]ew state level data from the CDC’s 2017 Behavioral Risk Factor Surveillance Survey (BRFSS) show that adult obesity rates rose by statistically significant amounts in six states and no states experienced a reduction in rates of obesity,” write the study authors. “According to the most recent National Health and Nutrition Examination Survey (NHANES), 18.5 percent of children and 39.6 percent of adults had obesity in 2015-2016. These are the highest rates ever documented by NHANES.” Those numbers suggest more than 93 million Americans are obese.

Alabama, Arkansas, Iowa, Louisiana, Mississippi, Oklahoma, and West Virginia were the seven states found to have adult obesity rates higher than 35%, according to the study. Only Hawaii, Colorado, and the District of Columbia had rates lower than 25%.

The CDC says that this public health crisis isn’t just widespread—it’s expensive. “The estimated annual medical cost of obesity in the United States was $147 billion in 2008 US dollars; the medical cost for people who have obesity was $1,429 higher than those of normal weight,” according to the agency.

But obesity is also a particularly difficult problem to solve given its disproportionate effect on racial minorities and poorer Americans. That’s tied to the wide-ranging, critical role that socioeconomics plays in public health, whether it be convenient access to affordable, nutritious food or a generally healthy environment. What’s clear is the problem is rampant, pricey (for individuals and the health system alike), and a tough issue to fix.

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