America just keeps getting fatter By Melissa Healy, Los Angeles Times Two decades ago, not a single state had an obesity rate above 15%. Now all states do. July 7, 2011

America continues to get fatter, according to a comprehensive new report on the nation's weight crisis. Statistics for 2008-2010 show that 16 states are experiencing steep increases in adult obesity, and none has seen a notable downturn in the last four years.

Meanwhile, cases of Type 2 diabetes and high blood pressure that health experts have long warned would result from the nation's broadening girth and sedentary ways are becoming increasingly widespread, according to the report, titled "F as in Fat," released Thursday.

Even Coloradans, long the nation's slimmest citizens, are gaining excess pounds. With an obese population of 19.8% — it is the only state with an adult obesity rate below 20% — Colorado remains the caboose on the nation's huffing, puffing train to fat land.

But in just the last four years, the ranks of the obese even in Colorado have grown 0.7%. Colorado's hypertension rates have risen significantly as well, to 21.2% of adults.

The report, prepared by the Robert Wood Johnson Foundation and the Trust for America's Health, is their sixth annual state-by-state accounting of obesity.

In the last 15 years, the report said, adult obesity rates have doubled or nearly doubled in 17 states. Two decades ago, not a single state had an obesity rate above 15%. Now all states do.

"When you look at it year by year, the changes are incremental," said Jeffrey Levi, executive director of the Trust for America's Health. But if you back up a generation and look at the slow but steady climb of Americans' weight, he said, "you see how we got into this problem."

Getting out of it will not be simple, Levi said. The report emphasized the need for a range of measures, including boosting physical activity in schools, encouraging adults to get out and exercise, broadening access to affordable healthy foods and using "pricing strategies" to encourage Americans to make better food choices.

"Until the government takes on the food industry, we'll continue to see the appalling numbers in this report," said Kelly D. Brownell, director of Yale University's Rudd Center for Food Policy and Obesity, who was not involved in the report. "These numbers signal an emergency, and we simply have to have the courage and resolve to do more than what we're doing.

"Government could start by changing agricultural subsidies, by not making it financially attractive for companies to market unhealthy foods, by placing serious restrictions on marketing to children, and with financial policies that make healthy foods cost less and unhealthy foods cost more."

The nation's roughly 4.5 billion excess pounds still skew heavily to the Southeast, with eight of the nation's 10 most obese states clustered near the Gulf and Atlantic coasts and along the southern Appalachian Mountains. Among the top 10, only Oklahoma and Michigan — which had a 1.2% increase in adult obesity in the last four years, the largest of any state — are outside the South.

Adult obesity in California, ranked 40th in the nation, held steady. Nearly 25% of adults fall in the obese category, meaning they have a body mass index, or BMI, of 30 or higher.

The state also was only one of two — the other was Texas — that saw an actual rise in levels of physical activity. About 21.9% of California adults surveyed told researchers they had not engaged in exercise or physical activity in the last 30 days — down from 22.8% in the last report, for the three-year period of 2007-2009.

That's a couch-potato rate far higher than those in active states such as Oregon, Colorado and Utah, but far lower than super-spud states such as Mississippi and West Virginia.

The increases in physical activity in California and Texas were the only bright spots in an otherwise grim reckoning. About 30 years after the United States started seeing a steep rise in the weight of children and adults, the illnesses most closely linked to obesity have begun a dramatic upturn. Diabetes rates in 12 states have jumped significantly, the report found, now affecting as many as 12.2% of adults in Alabama — the state with the highest obesity rates.

And in an alarming development, all but four of the nation's states saw rates of hypertension rise steeply enough that public health officials concluded the increase could not have been a statistical fluke. In Mississippi, the report found that 34.6% of adults have high blood pressure. In Alabama, the rate is 33.9%.

Obesity remains a condition disproportionately affecting those with poor education and income, and closely tied to minority status. Among African American adults, obesity topped 40% in 15 states. Among Latinos, it topped 30% in 23 states.

In contrast, among white adults, obesity rates were higher than 30% in only four states, and in no state topped 32.1%.

Nearly a third of high school dropouts are obese, compared with 21.5% of those who graduated from college or technical school.

For children, the picture from the report is slightly better, said Dr. Francine Kaufman, an obesity specialist at Children's Hospital Los Angeles. "Children are for the most part holding steady," she said.

Kaufman added that the report's clear message — that obesity takes its greatest toll in low-income and minority communities — underscores that "assistance programs are definitely required" to help those populations.

The report is based on surveys conducted annually to gauge how Americans' behavior affects their health. Carried out by the University of Michigan's School of Public Health, the Behavioral Risk Factor Surveillance System culls information from more than 1.2 million American adults. To gauge broad trends over time, the authors of "F as in Fat" have broken down those findings by state and calculated three-year averages, a technique that smoothes out yearly variations.