WASHINGTON - Like a lot of people, the nation's weight problem is settling below its waistline. The states with the highest percentages of obese adults are mostly in the South: Mississippi, Alabama, West Virginia, Louisiana, and Tennessee.
In the entire nation, only Oregon isn't getting fatter. New York's percentage of obese adults increased 0.6% to 21.2%.
Some 22.7% of American adults were obese in the 2002-04 period, up slightly from 22% for 2001-03, says the advocacy group Trust for America's Health, citing data from the Centers for Disease Control and Prevention.
Alabama had the biggest increase. There, the obesity rate increased 1.5 percentage points to 27.7%.
Eight states came in under 20%: Colorado, Massachusetts, Rhode Island, Connecticut, Vermont, Montana, Utah, and New Hampshire. But their figures were all rising. Oregon held steady at 21%.
Hawaii was not included in the group's report yesterday.
While certain regions of the country fared worse than others, particularly the Southeast, the organization said that no state met the federal government's goal of a 15% obesity rate for adults by 2010.
An adult with a body mass index of 30 or more is considered obese. The equation used to figure body mass index is body weight in kilograms divided by height in meters squared. The measurement is not a good indicator of obesity for muscular people who exercise a lot.
"Bulging waistlines are growing, and it's going to cost taxpayers more dollars regardless of where you live," said Shelley Hearne, the organization's executive director.
Why the geographic patterns? Experts don't have any one clear answer. Some suggest that urban sprawl plays a role. Others say it's easier to find a burger and fries than apples and asparagus in poor communities.
Dr. Delia West, a professor of public health in Arkansas, said demographics play a part. The South has a larger percentage of minorities, who have shown an increased risk for obesity. She said Southerners also tend to lead a more sedentary lifestyle than their counterparts in states such as Colorado or Oregon. People will find fewer jogging trails in Little Rock than in Denver, she said.
Also, the Southern diet probably plays a role, said Dr. West, a professor at the University of Arkansas for Medical Sciences. "We know the difference between purple hulled peas and speckled butter beans," she said. "But we make them with bacon fat or salt pork, so even though we're getting the micronutrients, it often comes laden with these extra calories."
Ms. Hearne said America is stuck in a "debate limbo" bout how to confront obesity. She urged government action on several fronts, such as ensuring that land-use plans promote physical activity, that school lunch programs serve more healthful meals, and that Medicaid recipients get access to subsidized fitness programs, such as aerobics classes at the local YMCA.
Radley Balko, a policy analyst at the Cato Institute, said he was wary of the call for more government action on obesity. The institute is a think tank that prefers free-market approaches to problems. "I think obesity is a very personal issue. What you eat and how often you exercise, if that comes within the government's purview, it's difficult to think of what's left that isn't," Mr. Balko said.
Health policy analysts maintain that obesity increases the burden on taxpayers because it requires the Medicare and Medicaid programs to cover the treatment of diseases caused by obesity. The report issued yesterday said taxpayers spent $39 billion in 2003 for the treatment of conditions attributable to obesity.
Mr. Balko said it's not clear the government really knows how to persuade people to make better decisions. He said open-ended entitlement programs, such as Medicaid and Medicare, don't provide much of a financial incentive for people to watch their weight. The government just picks up the cost of treating diseases for those patients, regardless of the amounts, he said.
He prefers that the government give Medicaid and Medicare recipients an incentive to open medical savings accounts, which would allow them to save money when they do not access the health care system.