Posted by: Adam McCann

Americans are the fattest people in the world, not just stereotypically but statistically too. In fact, as of 2017, almost 40% of the U.S. population aged 15 and older is obese. But such a finding should come as no surprise, considering the huge availability of fast-food and increasingly cheaper grocery items that have negatively altered our diets. Unfortunately, the extra pounds have inflated the costs of obesity-related medical treatment to nearly $316 billion a year and annual productivity losses due to work absenteeism to more than $8.6 billion.

But certain places are more responsible than others for tipping the scale in favor of bad health. To identify them, WalletHub compared 100 of the most populated U.S. metro areas across 18 key indicators of weight-related problems. Our data set ranges from share of physically inactive adults to projected obesity rates by 2030 to healthy-food access. Read on for our findings, expert advice on tackling America’s growing obesity problem and a full description of our methodology.

1. Main Findings
2. Ask the Experts
3. Methodology

Main Findings

 

  Embed on your website<iframe src="//d2e70e9yced57e.cloudfront.net/wallethub/embed/10532/geochart-obesity4.html" width="556" height="347" frameBorder="0" scrolling="no"></iframe> <div style="width:556px;font-size:12px;color:#888;">Source: <a href="http://ift.tt/2DqlrCh>  

 

Fattest Cities in America

Overall Rank (1 = ‘Fattest’)	Metro Area	Total Score	‘Obesity & Overweight’ Rank	‘Health Consequences’ Rank	‘Food & Fitness’ Rank
1	Little Rock-North Little Rock-Conway, AR	81.03	9	1	1
2	Shreveport-Bossier City, LA	80.72	3	2	7
3	McAllen-Edinburg-Mission, TX	79.94	4	13	4
4	Memphis, TN-MS-AR	79.92	6	11	2
5	Mobile, AL	79.41	5	3	21
6	Knoxville, TN	79.18	2	12	15
7	Jackson, MS	78.28	15	8	3
8	Birmingham-Hoover, AL	78.18	10	16	5
9	Baton Rouge, LA	77.57	14	10	11
10	Lexington-Fayette, KY	76.68	11	6	23
11	Columbia, SC	76.61	12	23	6
12	Chattanooga, TN-GA	76.59	20	9	10
13	Lafayette, LA	76.57	13	14	20
14	Greenville-Anderson-Mauldin, SC	76.30	17	17	14
15	Louisville/Jefferson County, KY-IN	76.00	7	20	29
16	Nashville-Davidson--Murfreesboro--Franklin, TN	75.81	1	25	34
17	Canton-Massillon, OH	75.52	23	7	33
18	Winston-Salem, NC	74.95	30	4	25
19	Tulsa, OK	74.74	16	39	18
20	Greensboro-High Point, NC	74.73	19	15	27
21	Fayetteville-Springdale-Rogers, AR-MO	74.66	18	33	16
22	Huntsville, AL	74.57	8	100	19
23	Wichita, KS	74.27	24	45	8
24	Oklahoma City, OK	73.66	21	50	17
25	Detroit-Warren-Dearborn, MI	73.40	28	5	52
26	Fort Wayne, IN	72.86	22	21	36
27	Toledo, OH	72.79	53	24	13
28	Indianapolis-Carmel-Anderson, IN	72.36	31	19	42
29	Myrtle Beach-Conway-North Myrtle Beach, SC-NC	72.00	46	26	26
30	New Orleans-Metairie, LA	71.99	34	18	43
31	Columbus, OH	71.75	32	44	24
32	Charleston-North Charleston, SC	71.68	27	60	44
33	El Paso, TX	71.41	64	32	12
34	Augusta-Richmond County, GA-SC	71.41	68	28	9
35	Scranton--Wilkes-Barre--Hazleton, PA	70.85	40	46	54
36	Dayton, OH	70.75	49	29	45
37	Jacksonville, FL	70.49	29	41	58
38	Asheville, NC	70.43	52	53	38
39	Youngstown-Warren-Boardman, OH-PA	70.33	47	51	35
40	Charlotte-Concord-Gastonia, NC-SC	70.32	26	31	64
41	Allentown-Bethlehem-Easton, PA-NJ	69.99	25	87	47
42	Grand Rapids-Wyoming, MI	69.72	33	86	39
43	Kansas City, MO-KS	69.57	57	59	32
44	Dallas-Fort Worth-Arlington, TX	69.50	56	69	22
45	Durham-Chapel Hill, NC	69.14	36	81	46
46	San Antonio-New Braunfels, TX	69.05	51	54	41
47	Riverside-San Bernardino-Ontario, CA	68.88	76	30	30
48	Providence-Warwick, RI-MA	68.61	44	75	61
49	Cincinnati, OH-KY-IN	68.61	62	22	49
50	Tampa-St. Petersburg-Clearwater, FL	68.58	42	40	69
51	Baltimore-Columbia-Towson, MD	68.28	37	34	77
52	Akron, OH	68.10	50	85	40
53	Houston-The Woodlands-Sugar Land, TX	67.89	45	48	59
54	Raleigh, NC	67.70	43	82	57
55	St. Louis, MO-IL	67.49	54	56	63
56	Spokane-Spokane Valley, WA	67.14	88	36	50
57	Richmond, VA	67.05	95	43	28
58	Albuquerque, NM	66.97	70	62	48
59	Pittsburgh, PA	66.93	38	71	76
60	Worcester, MA-CT	66.83	87	35	60
61	Portland-South Portland, ME	66.78	69	73	62
62	Miami-Fort Lauderdale-West Palm Beach, FL	66.75	35	65	81
63	Manchester-Nashua, NH	66.52	86	47	73
64	New York-Newark-Jersey City, NY-NJ-PA	66.49	61	79	56
65	Hartford-West Hartford-East Hartford, CT	66.23	80	63	66
66	Des Moines-West Des Moines, IA	66.19	81	84	31
67	Phoenix-Mesa-Scottsdale, AZ	66.19	77	37	65
68	New Haven-Milford, CT	66.13	74	74	79
69	Springfield, MA	66.00	96	38	55
70	Las Vegas-Henderson-Paradise, NV	65.90	66	42	80
71	Atlanta-Sandy Springs-Roswell, GA	65.71	71	27	75
72	Omaha-Council Bluffs, NE-IA	65.66	72	66	68
73	Milwaukee-Waukesha-West Allis, WI	65.54	39	55	84
74	Anchorage, AK	65.48	84	70	51
75	Virginia Beach-Norfolk-Newport News, VA-NC	65.40	82	49	67
76	Orlando-Kissimmee-Sanford, FL	65.24	55	64	86
77	Austin-Round Rock, TX	64.88	48	67	82
78	Philadelphia-Camden-Wilmington, PA-NJ-DE-MD	64.73	60	52	91
79	Cleveland-Elyria, OH	64.71	41	88	70
80	Los Angeles-Long Beach-Anaheim, CA	64.49	63	72	78
81	Washington-Arlington-Alexandria, DC-VA-MD-WV	63.42	58	78	94
82	Boise, ID	63.19	83	58	88
83	Reno, NV	63.18	93	61	72
84	Tucson, AZ	62.95	90	57	85
85	Bridgeport-Stamford-Norwalk, CT	62.70	85	96	90
86	Sacramento--Roseville--Arden-Arcade, CA	62.03	59	89	95
87	San Diego-Carlsbad, CA	61.89	67	68	100
88	Chicago-Naperville-Elgin, IL-IN-WI	61.83	75	76	97
89	San Jose-Sunnyvale-Santa Clara, CA	61.61	65	98	89
90	Provo-Orem, UT	61.46	98	95	37
91	Ogden-Clearfield, UT	61.36	100	80	53
92	San Francisco-Oakland-Hayward, CA	60.40	73	99	92
93	Minneapolis-St. Paul-Bloomington, MN-WI	60.13	79	93	87
94	Denver-Aurora-Lakewood, CO	59.81	94	97	71
95	Boston-Cambridge-Newton, MA-NH	59.56	89	91	93
96	Colorado Springs, CO	59.43	92	92	83
97	Seattle-Tacoma-Bellevue, WA	59.10	78	83	99
98	Salt Lake City, UT	58.92	99	94	74
99	Honolulu, HI	58.65	97	90	96
100	Portland-Vancouver-Hillsboro, OR-WA	58.63	91	77	98

Ask the Experts

Fighting obesity requires a multi-level approach. We turned to a panel of experts for the best ways to address the problem, from the personal to policy level. Click on the experts’ profiles to read their bios and responses to the following key questions:

1. What are some tips for eating healthy without breaking the bank?
2. What are the biggest mistakes people make when trying to achieve and maintain a healthy lifestyle?
3. What is the impact of obesity on the economy and worker productivity?
4. Should employers play a role in helping workers maintain a healthy lifestyle? How?
5. What policies should government pursue to fight obesity and lower the cost of health care?

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• Amy Bidwell Assistant Professor, Undergraduate Advisement Coordinator and Nutrition Minor Coordinator in the Department of Health Promotion and Wellness at the State University of New York at Oswego
• Ben Kern Assistant Professor of Physical Education in the School of Kinesiology at the University of Louisiana at Lafayette
• Solveig A. Cunningham Associate Professor in the Department of Global Health at Emory University Rollins School of Public Health
• Kim O'Brien Associate Professor of Psychology in the College of Humanities and Social and Behavioral Sciences at Central Michigan University
• Joe Mazzola Secretary/Treasurer at the Society for Occupational Health Psychology, Associate Professor of Industrial and Organizational Psychology & Director of the Industrial and Organizational Psychology Master’s Program at Roosevelt University
• Ellen E. Fitzsimmons-Craft Instructor of Psychiatry and Postdoctoral Fellow in the Weight Management and Eating Disorders Program at Washington University School of Medicine
• Alyssa McGonagle Assistant Professor of Psychology & Organizational Science at The University of North Carolina at Charlotte
• Ryan C. Johnson Assistant Professor of Psychology at Ohio University
• Mary J. Christoph Postdoctoral Fellow in the Division of General Pediatrics and Adolescent Health at the University of Minnesota
• Erin Eatough Assistant Professor of Psychology in the Weissman School of Arts and Sciences at Baruch College and The Graduate Center at The City University of New York
• Ruth Henry Professor of Kinesiology and Vice Chair of the Department of Nutrition and Kinesiology at Lipscomb University

Amy Bidwell Assistant Professor, Undergraduate Advisement Coordinator and Nutrition Minor Coordinator in the Department of Health Promotion and Wellness at the State University of New York at Oswego

What are some tips for eating healthy without breaking the bank?

The key is to avoid processed foods and added sugar. People think they need to go on a fancy, expensive weight loss program, however, all they need to do is focus more on eliminating unwanted calories. They have to understand that everything that they put into their mouth has a hormonal response. Every time they ingest sugar or refined carbohydrates, their body immediately goes into fat storage mode. Just breaking that habit will cause a significant change. Also, focusing on eating healthy, whole, unprocessed foods. Unfortunately, the processed foods are cheaper, however, you need more of it to feel full, therefore, eating foods in their more natural state will be cheaper in the long run.

What are the biggest mistakes people make when trying to achieve and maintain a healthy lifestyle?

People do not understand that weight maintenance is more difficult than weight loss. Anyone can lose the weight, but most people gain it back because they do not exercise. Not only do you have to exercise, you must be physically active as much as possible. You can spend your hour in the gym in the morning before work but then sit all day. All the sitting will completely counteract the time in the gym. It is important to get up and move every hour to keep the body stimulating fat loss.

With that, you cannot just exercise to lose weight. 80 percent of weight loss is diet, yet 80 percent of weight maintenance is exercise. People who try to just exercise more to lose weight tend to overeat to compensate for the added caloric loss. You would basically have to run 5 miles/day, 6 days/week to lose 1 pound a week if you did not make any changes to your diet. Focusing on cutting out approximately 300-350 calories/day from what you eat, and then exercising 30-60 minutes to burn off another 150-200 calories can help to lose the weight. There is no magic pill. It takes hard work and discipline. It needs to just be a way of life.

What is the impact of obesity on the economy and worker productivity?

I have seen statistics that state that obesity costs the U.S. up to $200 million/year, and costs employers around $400-$500/year for every person suffering from obesity. This is why health promotion has such a place in our society. It is time to make obesity a priority as it is it a preventable disease that is killing us in more ways than one.

Should employers play a role in helping workers maintain a healthy lifestyle? If so, how?

I definitely think that employers should try and promote healthy lifestyle by offering wellness programs geared towards helping people lose and/or maintain their weight. This can be done by employing wellness educators. Just offering discounts on gym memberships is not enough, especially considering that, as stated above, exercise is not the only part of weight loss. Companies could also offer on-site food co-ops to help with consuming more whole foods, that are rich in nutrients and low in calories.

What policies should federal and/or state governments pursue to combat obesity and lower the cost of health care?

The first thing they need to do is subsidize health foods instead of cheap, processed foods. Someone should not be able to eat cheaper by buying processed, refined foods with no added nutritional value. The government must make obesity a priority and increase access to healthy foods (not just low-calorie) across the nation, especially in urban areas where they suffer from food deserts. Also, schools need to mandate physical activity in their schools daily, if not hourly. Many other countries require some sort of movement every hour. They have actually shown how this increases academic scores as well.

Ben Kern Assistant Professor of Physical Education in the School of Kinesiology at the University of Louisiana at Lafayette

What are the biggest mistakes people make when trying to achieve and maintain a healthy lifestyle?

The biggest mistake people make when trying to achieve a healthy lifestyle is failing to make behavior changes a permanent part of their life. For example, many people choose to begin an exercise program designed to promote weight loss and improve fitness, and in so doing, they make the exercise program an “addition" to their other commitments, which, by definition, becomes a temporary change. People who make this mistake often do not create a “non-negotiable” time to do their exercise, which makes it much easier to skip exercising in any given day. Those people who adhere to long-term regular exercise do so because the workouts they perform regularly are a part of their daily habits, similar to eating, bathing, etc. This concept applies to maintaining healthy behaviors, as well. When exercise and healthy eating become the default setting, so to speak, maintenance of the behavior is much more likely.

What is the impact of obesity on the economy and worker productivity?

Obesity is currently one of the most costly conditions with regard to health care spending. Depending on which source you consider, U.S. health care spending is at about $150-200 billion per year. Obese adults spend almost 50 percent more on health care than non-obese adults. We struggle in this country with health care that is not affordable for many, all the while preventable disease such as obesity and related disorders are the primary driver of increased costs. There is a nice summary page provided on the state of obesity site, which is produced by the Robert Wood Johnson Foundation.

Should employers play a role in helping workers maintain a healthy lifestyle? If so, how?

I do believe that employers should play a role in helping workers maintain a healthy lifestyle, because the health of their employees will have a long-term effect on the success of the organization. These long-term effects can be realized through increased productivity during work, less absenteeism, and less employee turnover; all of which result in less stress for business owners and employees. Per my comments on achieving and maintaining a healthy lifestyle, I think employers can help by creating a workplace sponsored “non-negotiable” space of time for employees to exercise, learn healthy habits, and socialize with fellow workers.

This idea is not new, as corporate fitness programs have been around for some time, however, full organizational commitment to programs is often lacking, and organizations often fail to garner the support of employees prior to implementing programs. A bottom-up approach that meets the employees’ individual needs/wants is advisable, along with top-down support for resources and time to participate in workplace health promotion.

What policies should federal and/or state governments pursue to combat obesity and lower the cost of health care?

I think state and federal governments need to look critically at bolstering early childhood education and school physical education programs, along with parent education about healthy eating, regular physical activity, and exercise. In particular, this focus needs to be most intense in lower socioeconomic areas. These areas have the highest rates of obesity and have the lowest access to health care and high-quality education. This community-based programming would be beneficial to the U.S. health care system, as people in these lower income areas require more health care services, but are often uninsured or underinsured, thus they end up utilizing more than they pay for.

Some economists/researchers have projected that the return on investment of quality educational programs for healthy eating and exercise would be very favorable. I also think that over time, problems such as income inequality and academic achievement gap between lower and high socioeconomic status individuals would decrease due to increased focus on education and health. This improvement would ultimately strengthen the U.S. economy by having a more highly educated and capable workforce.

Solveig A. Cunningham Associate Professor in the Department of Global Health at Emory University Rollins School of Public Health

What are some tips for eating healthy without breaking the bank?

There are many grains and pulses that are cheap, delicious, and nutritious. For example, lentils and rice or beans and rice are a favorite with kids and adults alike. Bulgur, couscous or farro are also easy to cook with a pesto sauce or other flavorful sauces. Many vegetables and fruits are also inexpensive, especially when they are in season.

What are the biggest mistakes people make when trying to achieve and maintain a healthy lifestyle?

Trying too hard can be counterproductive. Taking small steps to increase physically active time each day rather than being very ambitious with heavy exercise routines is often helpful; so is reducing intake of unhealthy foods rather very strict and sudden limitations.

What is the impact of obesity on the economy and worker productivity?

Obesity has been shown to increase sick time and worker disability, affect educational outcomes, and lower worker productivity; so, overall, obesity has negative implications for productivity.

Should employers play a role in helping workers maintain a healthy lifestyle? If so, how?

Employers benefit when employees are healthy. Some employers create opportunities for employees to walk during a lunch break (for example, a path and encouragement for walking clubs), to commute actively to work (for example, providing financial incentives to bike, walk or take public transport) or to eat healthily (for example, supporting a healthy food truck on premises, or providing a kitchen where people can heat and store their food).

What policies should federal and/or state governments pursue to combat obesity and lower the cost of health care?

Public transportation options may provide opportunities for better health, less obesity, and healthier, less polluted living environments.

Kim O'Brien Associate Professor of Psychology in the College of Humanities and Social and Behavioral Sciences at Central Michigan University

What are some tips for eating healthy without breaking the bank?

Healthy eating means eating the right number of calories for your metabolism and activity level, lots of fruits and veggies, low saturated fats, and low salt. Canned and frozen are just about as healthy as fresh. There is no evidence that organic or non-GMO foods are better for you, but they usually come with a bigger price tag, so I avoid those. Same with "power foods." Usually, trendy foods like acai berries or coconut oil (which has more saturated fat than butter) cost more, but there's no evidence that they help at all.

What are the biggest mistakes people make when trying to achieve and maintain a healthy lifestyle?

I think people try to do too much. They try to eat organic kale salads when, really, they want a burger; then they end up eating both. So, practice mindful eating and make change a little at a time. Choose one small goal at a time and focus on the things that make a big difference (e.g., eat five servings of fruits and veggies per day), rather than trying to overhaul your whole lifestyle. Those very rarely work for more than a couple weeks. Human beings have a limited amount of self-control each day, and you can exhaust it quickly if you do too much.

What is the impact of obesity on the economy and worker productivity?

Obesity has some influence on cardiovascular disease, cancer, and stroke, which are the leading causes of death. Obesity is said to account for 1 out of 6 deaths of adults in the U.S., and an increasing number outside. The health costs are enormous. The obesity epidemic is considered on par with smoking, but it's hard to think of eating a fast food value meal as having a cigarette.

Should employers play a role in helping workers maintain a healthy lifestyle? If so, how?

That's both a moral question and a practical question. On one hand, it's rude to talk about someone's weight. You don't know if they have an underlying issue (on average, only about 20-40 percent of weight gain/weight loss is within our control), and it could be very hurtful to someone recovering from cancer, anorexia, alcoholism, depression, etc. On the other hand, you probably care about your workers (and perhaps the insurance costs). I say it is not the organization's business, per se, but it is helpful to have voluntary weight loss/weight gain prevention interventions, such as hosting Weight Watchers, having a relationship with a nutritionist or health psychologist, or paying for gym membership. Mandatory health interventions are an invasion of privacy and generally disliked by employees.

What policies should federal and/or state governments pursue to combat obesity and lower the cost of health care?

This is also a moral question. Should the government limit sugary drinks? When there is a wealth of scientific evidence that some things have serious health risks (e.g., asbestos, trans fats, oxycontin), then the government is responsible for regulating. But, I think most people believe that the government shouldn't regulate what you do in your kitchen. If a person doesn't like broccoli, they shouldn't be forced by law to eat it, regardless of whether they receive food assistance or not. I think many Americans think the government should regulate what poor people eat, but not what other people eat, and this disparity is hypocritical, judgmental, and counterproductive.

I think a lot of people believe poor people can get healthier if they just try harder, but there are many people in the U.S. who have housing so lacking that they have no running water or kitchen to cook in. These people are likely to be obese because it's cheaper to buy a value meal than a stove. So, when it comes to regulation, laypersons believe that poor people and "everyone else" should have different rules, but I don't believe that to be fair. Regulate the things that are overwhelmingly shown to be unhealthy, but let people make their own decisions beyond that. I think that in the short term, this will raise costs (because we have to provide education and resources to people to make healthy decisions), but long-term, as people become healthier, decrease health care costs.

Joe Mazzola Secretary/Treasurer at the Society for Occupational Health Psychology, Associate Professor of Industrial and Organizational Psychology & Director of the Industrial and Organizational Psychology Master’s Program at Roosevelt University

What are some tips for eating healthy without breaking the bank?

While healthy food tends to be pricier, there are ways to minimize the costs. Keeping an eye out for sales and buying in bulk are good ways to get a lot of vegetables or lean meat/fish all at once at a reasonable price. See if you can find a low-cost produce grocer in your area and add it to your shopping routine. Similarly, just switching from eating main meals/lunches out to meal planning can save quite a bit of money over a month. Finally, the Mediterranean diet (and similar ones) has been shown to help people lose or maintain weight and health, and it involves a fair amount of grains and other foods that are cost-effective, but just need to be used correctly and portion controlled.

What are the biggest mistakes people make when trying to achieve and maintain a healthy lifestyle?

One of the biggest mistakes is trying to make huge changes all at once. Lots of people will say something like, "Starting today, I'm eating only fresh foods made at home and exercising 6 days a week!" and then, when they realize this wasn't sustainable after 4 days, they feel bad and give up. Make small goals (i.e., bring lunch 3 days a week, workout 3-4 days a week for 30 minutes), then once you accomplish that, up the goals to something more difficult. For some, just making lifestyle changes like walking at lunch might be enough to start moving towards a healthier lifestyle. Another is thinking they have to give up everything they love to be healthy, which again, isn't sustainable. Most health researchers will tell you that a cheat day is good for you. It gives you something to shoot for and stops your body from going into starvation mode. The key, of course, is to make it through the other days following your health goals to "earn" that cheat day.

What is the impact of obesity on the economy and worker productivity?

There is a notable impact of obesity on work outcomes. Obesity, in general, is linked to poorer health outcomes, which leads to higher rates of absenteeism and higher insurance costs/premiums. Obese and overweight individuals obviously struggle more in jobs that require physical exertion of any kind, although productivity can be affected even in sedentary jobs. In a broader sense, obesity and obesity-related disorders cost society a lot in medical bills, lost productivity, and care resources that could go elsewhere.

Should employers play a role in helping workers maintain a healthy lifestyle? If so, how?

Absolutely. For one, we as Americans spend a large amount of time at work (more than 45 hours a week on average for full-time workers, based on some sources), so if the time spent there isn't part of the solution to an unhealthy lifestyle, then it is likely part of the problem. Second, organizations have a unique opportunity to affect a large amount of people with relatively low cost and less effort for the individual to access it (and they have incentive to do so because of the lower insurance premiums and potential increase in productivity).

We actually did a study asking people about the organization's role in health, and most believed the organization should be part of promoting health, and almost all were at least fine with organizations’ efforts to increase health, even if they wouldn't participate. There are many ways organizations can do this, and most don't involve building an expensive gym. Information campaigns (e.g., flyers, email blasts), screening and counseling based on health risks, and small workplace interventions (e.g., offering yoga classes, starting a walking club, increasing healthy food options in cafeterias and meetings) can all have positive effects on health and workplace culture. Many health insurance companies have infrastructures already in place for these types of initiatives.

What policies should federal and/or state governments pursue to combat obesity and lower the cost of health care?

One of the best things governments can do is support prevention efforts. Helping people pay for preventative care and/or gym memberships costs little compared the medical costs associated with a heartache or major injury/surgery. The continued efforts to get kids moving and to help them see the value of healthy eating and exercise is also important. There are also so many ways that people like to exercise and having avenues to do the exercise type that they actually enjoy can be important in keeping someone active. Investing in national parks (for hiking), running trails, baseball and soccer fields, and natural water sources (for kayaking and paddle boarding) will likely help people with their efforts to exercise in the way that improves not only health, but also quality of life.

Ellen E. Fitzsimmons-Craft Instructor of Psychiatry and Postdoctoral Fellow in the Weight Management and Eating Disorders Program at Washington University School of Medicine

What are some tips for eating healthy without breaking the bank?

The number one way individuals can eat healthy on a budget is by planning in advance -- for example, by looking for sales and coupons for healthy, nutrient-dense foods in advance, rather than showing up to the grocery store without a specific plan. Plan ahead to purchase based on sales/coupons or to buy produce that is in season, which usually costs less than produce out of season. Other specific suggestions for buying healthy foods on a budget are:

• Buy regular (not instant) grains and day-old bread -- these options cost less, but are just as nutritious;
• Use or check the bulk aisle for things like dry beans and grains -- the price per pound is almost always less expensive;
• Purchase some frozen and canned vegetables and fruits, which can be good alternatives to fresh and they won’t spoil;
• Avoid “pre-packaged” produce, like pre-bagged salad or pre-cut fruit -- stores increase the price for these items and the consumer ends up paying for the convenience;
• Buy in bulk -- meats, dairy, and grains are often less expensive in bigger quantities;
• Be open to trying new and different brands, based on what may be on sale or have a coupon.

What are the biggest mistakes people make when trying to achieve and maintain a healthy lifestyle?

One of the biggest mistakes people make when trying to achieve and maintain a healthy lifestyle is embarking on a diet or physical activity plan that is not sustainable. A plan like this might lead to short-term weight loss but is not a sustainable solution for healthy weight maintenance in the long term. In order to achieve and maintain a healthy lifestyle, it takes changing the health behaviors, like the nutritional quality of the foods eaten within and outside of the home, physical activity behaviors, and sleep quality and quantity, of the entire home; that is, not just the behaviors of the individual, but also of their partner and/or their children. In order to make these kinds of lifestyle changes sustainable, it’s important to make the healthy choice the easy choice, which really requires re-engineering all areas of the individual's life -- their home environment, friendship network, school or work setting, and use of community resources.

Seeking out supports in these different areas will make it a lot easier for an individual to sustain healthier habits. It is important to turn the focus on what one can do or have instead of what one cannot do or have, as this creates restrictions and is not sustainable. Furthermore, enjoying all foods in moderation is important, but individuals might experiment with new and delicious ways to season and prepare foods that still allow them to enjoy the foods they like, but in a healthier way. There is also not one single perfect form of physical activity for weight loss. It is important for individuals to do activities that they enjoy and that they want to make a part of their daily life -- doing something you like is a lot more sustainable than doing something you really don’t enjoy.

What is the impact of obesity on the economy and worker productivity?

The estimated annual health care costs of obesity-related illnesses are over $190 billion, which is a staggering 21 percent of annual medical spending in the U.S. Childhood obesity alone is responsible for $14 billion in direct medical costs. Obesity-related medical costs in general are expected to rise significantly in the coming years, as childhood obesity rates rise, and as today’s children with obesity become tomorrow’s adults with obesity. It is important to note that the costs attributable to obesity are almost entirely a result of costs generated from treating the diseases that obesity promotes -- not treating obesity itself. The annual costs of obesity-related absenteeism in the U.S. range between $3.38-$6.38 billion. Because of obesity and its consequences, young people of today are projected to live shorter lives than their parents.

Should employers play a role in helping workers maintain a healthy lifestyle? If so, how?

Employers can play a very important role in helping workers maintain a healthy lifestyle. For instance, offering comprehensive, evidence-based weight management programs as part of workplace wellness options has been demonstrated to provide a return on investment. Such programs can help individuals lose costly obesity-related comorbidities, such as type 2 diabetes and hypertension. These programs can also help to decrease the costs associated with obesity-related absenteeism from work. Employers can create environments that help their employees make the healthy choice the easy choice as well -- for example, by providing healthy food options at work, and employee parties that center on physical activity rather than eating less healthy foods. These effects can then generalize to the employee’s family members, like their children, potentially improving the health of generations to come and, ultimately, saving money.

What policies should federal and/or state governments pursue to combat obesity and lower the cost of health care?

Policies at the federal and state government levels must increase access to effective care for obesity, as we currently spend a lot of money treating the comorbidities of obesity rather than the obesity itself. Obesity affects more than 35 percent of men and 40 percent of women, and one in 13 Americans has severe obesity. One in six children has obesity, with 80 percent of these children going on to having obesity in adulthood and suffering from diseases once only seen in adulthood.

The United States Preventative Services Task Force recommends that adults and children with obesity be referred to intensive, multicomponent behavioral programs, but currently, access to this kind of treatment is extremely limited and not often covered by insurance providers. We must increase access to this kind of care and begin paying to treat obesity itself rather than only when it has manifested itself as another disease, like type 2 diabetes. We should especially focus on early intervention with children with obesity, when the problem is easier to treat and less entrenched.

Alyssa McGonagle Assistant Professor of Psychology & Organizational Science at The University of North Carolina at Charlotte

What is the impact of obesity on the economy and worker productivity?

Obesity is unfortunately associated with chronic health conditions, which can lead to worker absenteeism. A study from the Gallup organization found that U.S. workers with chronic health conditions, including obesity, were absent from work much more often than healthy workers, leading to an estimated $153 billion lost in worker productivity per year.

Another problem is presenteeism, which refers to showing up for work when ill. Research actually shows that there is more overall workplace productivity loss due to presenteeism than absenteeism.

Should employers play a role in helping workers maintain a healthy lifestyle? If so, how?

Yes, employers should absolutely play a role. One of the risk factors for obesity in workers is shift work. Workers who work nights or rotating shifts may experience a double whammy: their circadian rhythms are off, causing possible digestive issues, and they typically do not have easy access to fresh food during night shifts. Providing access to healthy food options is important, as is adequate break times for meals, and following recommended guidelines for shift work scheduling.

My own research has indicated that “work-health conflict” is a real problem for many workers with chronic health conditions, including obesity. Affected workers feel that they cannot take adequate care of themselves to stay healthy due to work demands unduly impeding on their time, causing them stress, and depleting their energy.

One way to combat work-health conflict and to help workers maintain a healthy lifestyle is to provide workers with control and flexibility in managing their schedules (flextime) so that they can better integrate their health needs with their work. Another way is to allow workers to complete work where they choose, when possible (flexplace). Overall, an organizational focus on results, rather than facetime, can help workers self-manage demanding work, health, and family roles.

Support from supervisors for managing both work and life is also critical. For example, supervisors can verbally express support for workers, request input when scheduling, and encourage and approve requests for time off to exercise, attend medical appointments, or for other health-related activities.

In a series of studies, researchers from the Work, Family, and Health Network found that interventions focused on increasing worker control and improving levels of support from supervisors for managing work and life showed positive benefits for workers with high levels of work-family conflict. In samples of health care workers and grocery store workers, training supervisors to be more supportive resulted in better health and work attitudes for their subordinates who had high levels of work-family conflict. The researchers also found similar benefits from a combined job control and supervisor support intervention on IT workers and extended care nursing facility workers with elder care responsibilities.

Ryan C. Johnson Assistant Professor of Psychology at Ohio University

What is the impact of obesity on the economy and worker productivity?

The economic impact of obesity is likely linked to both reduced productivity and additional health care expenditures. For instance, if an obese employee is also managing a comorbid condition (e.g., type 2 diabetes), they may utilize health care resources at a higher rate, resulting in increased costs for their employer. Simultaneously, managing their comorbid condition may make it more difficult for them to successfully meet the demands of their job. There is also emerging evidence of anti-fat bias in the workplace, which, if operating through hiring and promoting decisions, may result in negative long-term financial consequences indirectly associated with obesity. These are complicated questions operating at multiple levels and through various pathways, which makes it difficult, but not impossible, for employers to evaluate the cost-benefit ratio of health promoting initiatives.

Should employers play a role in helping workers maintain a healthy lifestyle? If so, how?

They should, and many do play important roles in helping workers stay healthy, both physically and psychologically. These efforts range from large-scale interventions (e.g., healthy food, on-site fitness centers, and preventative health care) to smaller, day-to-day psychosocial and job design considerations (e.g., supportive supervision, flexible work arrangements, and wellness training). Indeed, many organizations have “gamified” participation in various wellness programs and incentivize employees financially to lead healthier lives (e.g., bonuses for not using tobacco products). Overall, these initiatives are positively received, and for many employees, their workplace may be their primary (or only) source of preventative care and education about living a healthier lifestyle.

Researchers and health care providers have begun to view the workplace as a primary point of intervention, which makes sense, considering that most of us spend most of our waking hours at work. Employers do walk a fine line, and not all employees are happy if they perceive their employer as overstepping into their personal lives.

What policies should federal and/or state governments pursue to combat obesity and lower the cost of health care?

As an occupational health scientist, I might be a little biased, but I think more funding for high-quality applied research is key to informing policy. The National Institute for Occupational Safety and Health’s (NIOSH) Total Worker Health® initiative is one such example. We need to better understand the links between the experience of working and obesity, and develop and evaluate interventions before enacting policy. That being said, there is a lot that we do know (e.g., diet and exercise), and incentivizing employers to support their employees’ healthy decisions, perhaps through policy, is an easy first step.

Mary J. Christoph Postdoctoral Fellow in the Division of General Pediatrics and Adolescent Health at the University of Minnesota

What are some tips for eating healthy without breaking the bank?

There are many ways to eat well without spending a fortune. If you approach providing healthy, high quality, and affordable meals for your household as a challenge and opportunity for creativity, I think it can serve you well. Nutrition is absolutely crucial, because it impacts your long-term risk of many diseases, such as coronary heart disease and cancer, but it also impacts your daily energy and ability to function at a high level. Below are a few specific ways to eat high-quality food on a budget.

Cook at home. The U.S. Bureau of Labor Statistics estimates that about 44 percent of annual household food expenditures is spent on food away from home. Restaurant food is often far more expensive and can be less healthy. Ruopeng An at the University of Illinois found that consumers ate fewer calories and less sodium, among other things, when they had full-service restaurant foods at home rather than away from home (Eur J Clin Nutr, 2016), suggesting that even if the food is the same, environment matters. One of the easiest ways to eat less restaurant food is to establish some fast and easy “default” meals, for which you always keep the ingredients on hand.

At the grocery store and home:

• Shop at discount grocery stores, particularly for high-ticket items, such as nuts and seeds;
• Eat smaller portions (or lower the frequency) of expensive items such as meat, fancy cheeses, and alcohol;
• Replace expensive items with cheaper items within the same category (e.g., cheaper cuts of meat and frozen or canned rather than fresh seafood);
• Buy less-processed versions of items you typically purchase (e.g., dried instead of canned beans, whole fruit/vegetables/cheeses rather than pre-cut or pre-shredded);
• Rather than buying baked goods and pre-made items, make them at home;
• Slow the pace of your eating, paying attention to your satiety level;
• Be careful about coupons; while they might seem like a money-saver, you’re not necessarily saving if you weren’t planning to purchase the product in the first place; plus, these are often higher-priced items, and can also be less healthy (check the label and compare it to similar products).

In general, you could incorporate more of these healthy food groups that are typically under-consumed by Americans: beans and legumes, nuts and seeds, seafood, many different types of fruits and vegetables, and whole grains.

What are the biggest mistakes people make when trying to achieve and maintain a healthy lifestyle?

Eating well, managing stress, being physically active, getting enough sleep, and having strong social connections are some of the major factors supporting overall health. A common mistake is taking an “all-or-nothing” approach, thinking that you have to tackle all of these factors at once, or that if you’re not deadlifting enormous weight or running 10 miles multiple times per week, you might as well not even bother. However, even the smallest improvement in any of these factors can help. Additionally, if you start small and give yourself time to develop habits and build these things into your life, it can have a much longer-term impact.

While this isn’t a mistake per se, another common approach is simply letting inertia work. Rather than letting life happen to you, taking some time to strategize about how you can be healthier, and then planning and experimenting with different strategies until you find one that you enjoy and works into your life can help immensely.

Should employers play a role in helping workers maintain a healthy lifestyle? If so, how?

Absolutely. The type of work you perform, your work hours, and workplace amenities and culture can all have a profound impact on health. For instance, in a recent analysis my colleague Megan Winkler at the University of Minnesota performed, she found that working non-standard (i.e., anything but the regular day shift) hours was associated with poorer health and behavioral outcomes. Particularly, as we see an increased number of workers in the gig economy who might be working remotely and/or non-standard hours, it will be important for companies to take the lead in creating a good environment and promoting health among their employees.

Erin Eatough Assistant Professor of Psychology in the Weissman School of Arts and Sciences at Baruch College and The Graduate Center at The City University of New York

What is the impact of obesity on the economy and worker productivity?

We know from the empirical research that obesity is linked to lost time due to injury, illness and disability. We also know that obese employees experience a slower recovery compared to workers with a healthy body mass index (BMI) score. Obesity is then likely quite relevant to the productivity of the employee, because they may be at more risk for missing work, suffering other health conditions which require time off or lead to absence due to sickness, and when this happens, they unfortunately may need to be away for a more extended period than a non-obese employee.

However, we also know that there is a point of entry for change within the workplace. For example, not giving employees an adequate amount of job control is associated with BMI gain. Job control can come in the form of control over when one works (e.g., flextime) or where one works (like allowing for telecommuting some portion of the week). For example, the saving in commute time could be allocated for things like exercise. In addition, requiring long work hours is linked to greater BMI, particularly for men. So, while obesity could translate into lost productivity through lost time at work, employers can help solve the problem by allowing for adequate control over work and giving employees the time they need to address their health issues (like through adequate hours off). In the long run, this could be better for both the individual and the organization.

Should employers play a role in helping workers maintain a healthy lifestyle? If so, how?

Yes, I think employers have a responsibility to consider whether the work allows the ability to maintain a healthy lifestyle, and I think they have responsibility to foster a healthy lifestyle for their employees. Policies, programs, and practices can all be targets of intervention to protect and promote the health of the workforce.

Ruth Henry Professor of Kinesiology and Vice Chair of the Department of Nutrition and Kinesiology at Lipscomb University

What are the biggest mistakes people make when trying to achieve and maintain a healthy lifestyle?

Often, people try to make too many changes at once. Small changes that can be maintained for a lifetime are the ones that will make the biggest difference in your health. When people try to take giant steps, the whole process can be overwhelming and many times, they end up just quitting.

Should employers play a role in helping workers maintain a healthy lifestyle? If so, how?

Employers can do so much to encourage their workers to maintain a healthy lifestyle. They can offer worksite wellness programs led by qualified wellness professionals. That is the best step that can be taken. If that is not possible, they can offer fitness facilities at work; if onsite space is an issue, some companies even subsidize the employees' membership fees for YMCA. They can offer healthy choices in the company cafeteria. Some also offer incentives, either cash or otherwise, for healthy lifestyles, with points awarded for exercise and attending educational sessions. The possibilities are endless, and there are steps that a company of any size can make in the right direction.

Methodology

In order to determine the fattest cities in America, WalletHub compared 100 of the most populated U.S. metro areas across three key dimensions: 1) Obesity & Overweight, 2) Health Consequences and 3) Food & Fitness.

We evaluated those dimensions using 18 relevant metrics, which are listed below with their corresponding weights. Each metric was graded on a 100-point scale, with a score of 100 representing the “fattest.” Data for metrics marked with an asterisk (*) were available only at the state level.

We then determined each city’s weighted average across all metrics to calculate its total score and used the resulting scores to rank-order our sample.

Obesity & Overweight – Total Points: 60

• Share of Overweight Adults: Full Weight (~13.33 Points)
• Share of Obese Adults: Full Weight (~13.33 Points)
• Share of Overweight Teenagers: Half* Weight (~6.67 Points)Note: “Teenagers” includes persons aged 14 to 18.
• Share of Obese Teenagers: Half* Weight (~6.67 Points)Note: “Teenagers” includes persons aged 14 to 18.
• Share of Overweight Children: Half* Weight (~6.67 Points)Note: “Children” includes persons aged 10 to 17.
• Share of Obese Children: Half* Weight (~6.67 Points)Note: “Children” includes persons aged 10 to 17.
• Projected Obesity Rates by 2030: Half* Weight (~6.67 Points)

Health Consequences – Total Points: 15

• Share of Adults with High Cholesterol: Full Weight (~5.56 Points)
• Share of Diabetic Adults: Full Weight (~5.56 Points)
• Share of Adults with High Blood Pressure: Full Weight (~5.56 Points)
• Heart-Disease Rate: Full Weight (~5.56 Points)
• Obesity-Related Death Rate: Half* Weight (~2.78 Points)

Food & Fitness – Total Points: 15

• Share of Adults with Low Fruit/Vegetable Consumption: Full* Weight (~1.67 Points)
• Share of Residents Who Say They Eat Healthy: Full Weight (~1.67 Points)
• Access to Healthy Food: Full Weight (~1.67 Points)Note: This metric measures the percentage of urban-area residents who earn a low income and live more than 1 mile from a grocery store or supermarket.
• Share of Physically Inactive Adults: Full Weight (~1.67 Points)
• City Friendliness toward an Active Lifestyle: Quadruple Weight (~6.67 Points)Note: This metric is based on data from WalletHub’s Best & Worst Cities for an Active Lifestyle ranking.
• Access to Parks & Recreational Facilities: Full Weight (~1.67 Points)

 

Sources: Data used to create this ranking were collected from the Centers for Disease Control and Prevention, County Health Rankings, United States Department of Agriculture Economic Research Service, Child and Adolescent Health Measurement Initiative, Gallup, Trust for America's Health and WalletHub research.

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