The south dominates list of America’s fattest places, led by one Appalachian state

West Virginia ranked as America’s most overweight and obese state in a new WalletHub analysis, with Southern states taking the top seven places. The results highlight regional differences in health risks and access to nutritious food, while drawing attention to the costs associated with obesity.

The ranking covered 50 states and Washington, DC, using 31 factors, including obesity rates, projected diabetes cases, sugary drink consumption and access to healthy foods. In West Virginia, 42% of adults were classified as obese and nearly 32% as overweight; Mississippi and Arkansas ranked second and third. Colorado ranked lowest for excess weight, and US obesity-related healthcare costs were estimated at $173 billion a year.