Posted by: Richie Bernardo

“Fat” is becoming the new normal in America. According to the most recent data from the Centers for Disease Control and Prevention, more than seven in 10 U.S. adults aged 20 and older are either overweight or obese. Rates are lower for children and adolescents but have risen steadily almost every year. So prevalent has America’s obesity problem grown that the weight-loss industry continues to expand. This year, Americans are expected to spend more than $68 billion just on programs designed to help them shed the extra pounds. The U.S. spends in total nearly $200 billion in annual health care costs related to obesity.

New findings by the Physical Activity Council suggest a need for more aggressive efforts to combat the issue. According to the report, nearly 81.5 million Americans aged 6 and older were completely inactive in 2016. Lack of physical activity is a leading cause of obesity, in addition to genetics, emotional instability and sleeplessness.

But the problem is bigger in some states than in others. To determine where obesity and overweight most dangerously persist, WalletHub’s analysts compared the 50 states and the District of Columbia across 19 key metrics. Our data set ranges from share of obese and overweight population to sugary-beverage consumption among adolescents to obesity-related health care costs. Read on for our findings, expert commentary from a panel of researchers and a full description of our methodology.

For a more local perspective on the obesity and overweight problem in the U.S., check out WalletHub’s Fattest Cities report.

1. Main Findings
2. Most & Least Obese States
3. Ask the Experts
4. Methodology

Main Findings

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Fattest States in America

Overall Rank (1 = Fattest)	State	Total Score	‘Obesity & Overweight Prevalence’ Rank	‘Health Consequences’ Rank	‘Food & Fitness’ Rank
1	Mississippi	66.44	1	2	4
2	West Virginia	65.55	4	1	12
3	Tennessee	61.90	2	11	11
4	Arkansas	61.72	5	6	8
5	Louisiana	60.64	3	7	5
6	Kentucky	60.53	7	10	7
7	Alabama	59.07	8	21	6
8	Oklahoma	58.35	6	36	1
9	South Carolina	57.15	10	22	18
10	Indiana	56.60	15	8	16
11	Texas	56.14	9	24	9
12	Iowa	55.74	17	5	15
13	Ohio	55.02	11	25	2
14	Delaware	54.98	12	17	44
15	Kansas	54.80	13	15	10
16	North Carolina	54.73	19	13	22
17	Georgia	54.20	14	16	3
18	Michigan	54.18	18	19	13
19	North Dakota	53.56	16	37	21
20	New Mexico	53.07	28	9	17
21	Alaska	52.55	33	4	28
22	Nebraska	52.20	23	27	31
23	Florida	52.03	20	33	39
24	Maryland	51.41	25	30	34
25	Pennsylvania	51.37	24	38	32
26	Rhode Island	51.14	26	26	45
27	Missouri	51.12	27	39	24
28	Wisconsin	51.03	21	23	29
29	Maine	50.78	29	29	19
30	Arizona	50.60	31	20	25
31	South Dakota	49.98	22	49	20
32	Illinois	49.71	30	31	26
T-33	Vermont	48.57	49	3	41
T-33	Wyoming	48.57	37	35	30
35	New York	47.99	38	32	46
36	Idaho	47.89	40	28	43
37	Washington	47.47	42	14	42
38	Virginia	47.39	39	42	37
39	District of Columbia	46.99	41	43	36
40	Minnesota	46.93	34	41	23
41	California	46.86	35	45	49
42	Oregon	46.49	48	12	38
43	New Hampshire	45.90	44	33	48
44	Nevada	45.71	36	51	33
45	New Jersey	45.53	32	44	47
46	Connecticut	44.58	43	46	50
47	Montana	44.57	47	40	35
48	Hawaii	43.94	46	50	27
49	Utah	43.72	51	18	14
50	Massachusetts	43.30	45	48	51
51	Colorado	39.87	50	47	40

Most & Least Obese States

Although this report examines the prevalence of obesity, it also evaluates the levels of inactivity and overweight in each state. However, given the particularly harmful effects of obesity, we constructed a separate table below that focuses just on obesity rates to highlight the states in which the problem is most concerning. Both adults and children were considered for this separate ranking. A rank of No. 1 corresponds with the highest obesity rate.

Embed on your website<iframe src="//d2e70e9yced57e.cloudfront.net/wallethub/embed/16585/geochart-obese.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/2yDaob1;  

Ask the Experts

Our collective medical tab of nearly $200 billion is just one of the consequences of a perpetually unhealthy lifestyle that leads to obesity. To shed more light on the issue and find solutions that consumers and local governments can follow, we asked a panel of experts to share their thoughts on 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 lose weight?
3. What policies should government pursue to combat obesity and rein in the cost of health care?
4. What is the impact of obesity on the economy and worker productivity?
5. Should overweight people pay a higher premium for their health insurance? Do you think they will in the future, based on recent health care proposals?

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• Reyna Franco Nutrition and Exercise Consultant and Co-Chair of the New York State Academy of Nutrition and Dietetics
• Nancy Z. Farrell Registered Dietitian Nutritionist at Farrell Dietitian Services & Adjunct Instructor at Germanna Community College
• Melissa Halas-Liang Media Representative for the California Academy of Nutrition and Dietetics
• Mary Cluskey Associate Professor of Nutrition, Dietetic Internship Director, and Director of the Healthy Foods and Diet Core for the Moore Family Center for Whole Grains and Preventive Nutrition at Oregon State University
• Lydia Kret Lecturer in the Dietetics and Human Nutrition Program at Eastern Michigan University
• Kent Adams Department Chair and Professor of Kinesiology at California State University, Monterey Bay
• Joseph A. Skelton Associate Professor of Pediatrics at Wake Forest Baptist Medical Center
• Jonathan Valdez Public Policy Coordinator and Co-Chair of the Greater New York Dietetic Association, New York City and Long Island Media Representative at New York State Academy of Nutrition and Dietetics, and Online Professional Development Coordinator at the National Organization of Men in Nutrition
• Elizabeth Larson Associate Professor with the Department of Kinesiology's Occupational Therapy Program at the University of Wisconsin-Madison School of Education
• Bhimanagouda S. Patil Professor of Horticulture & Director of the Vegetable and Fruit Improvement Center at Texas A&M University
• Amanda Arguello Morris Adjunct Faculty in the Health & Wellness Program at Tulane University

Reyna Franco Nutrition and Exercise Consultant and Co-Chair of the New York State Academy of Nutrition and Dietetics What are some tips for eating healthy without breaking the bank?

• Buy in bulk -- this includes beans, nuts, seeds, and whole grains such as oats, brown rice and quinoa;

• Buy frozen vegetables and fruit (without added salt or oil) -- all the nutrients are preserved in the vegetable or fruit when it is flash-frozen;

• Plan meals in advance and only buy the foods you need for your meals;

• Use coupons but only for food you need, not for food you want -- just because something is on sale doesn't mean you should buy it;

• Cook double portions of your meals and freeze individual portions for future meals -- this reduces the need to go out to eat or ordering in, which is more expensive than cooking;

• Beans are a low-cost and high nutritional value protein -- either use dry beans or canned beans (without added sodium).

What are the biggest mistakes people make when trying to lose weight?

• People think that the more they exercise, the more weight they will lose. Unfortunately, this is not necessarily true. Exercise tends to increase the appetite and people often eat the calories they burn.

• Cheat days can be a big mistake. After eating healthfully for six days, some people feel they can have a cheat day and eat all they want. Often, the amount of calories they eat on the cheat day is so substantial that they actually gain weight.

• Cutting back on food intake but drinking their calories whether it is from smoothies, soda, juice or alcohol.

• Not eating during the day and ending up binge eating.

Nancy Z. Farrell Registered Dietitian Nutritionist at Farrell Dietitian Services & Adjunct Instructor at Germanna Community College What are some tips for eating healthy without breaking the bank?

• Every time you eat is not a party or a time for celebration foods. Keep those items for really special moments. Instead, have 80 percent of your intake consist of nutrient rich foods. Stop and think beforehand, and ask yourself what health benefit is this food providing, or how long do you have to walk to work this off?

• Eat three evenly spaced meals a day. And very importantly, remember that you may have not eaten or hydrated for 10 hours, so the first good habit to form is to wake up and drink 8-12 ounces of water, and then eat a breakfast with protein and fiber, like yogurt and granola, whole wheat toast topped with nut butter and slices of strawberries and a glass of milk (or at least reduced fat milk in your coffee), oatmeal made with milk and topped with nuts/seeds and berries, etc.

• Plate composition -- half of every lunch and supper plate should consist of veggies. In other words, eat one cup of veggies every lunch and every supper, as this provides minimal calories, antioxidants to slow aging, improve eyes, heart, skin etc. You say you don’t like veggies -- there are approximately 400 varieties. There has to be a handful you like. It takes 15 attempts to like a food, and sometimes that means trying different varieties or different preparation methods. For example, roasted Brussels sprouts taste different than boiled. Or canned beets vs. fresh beets on a salad with balsamic dressing, or even freshly made beet chips. Then, a quarter of the plate is a lean protein, and the last quarter of the plate is a whole grain. This all follows the USDA MyPlate concept.

• Reduced fat and low-fat dairy is a great weight management tool -- this can be in the form of milk, yogurt, or cottage cheese. Nutrients -- calcium (bones, heart function), protein (cell integrity, lean body mass), potassium (important for renal/kidney patients).

• Portion control -- half a cup is the size of a tennis ball. A serving of meat should be no larger than a deck of cards.

What are the biggest mistakes people make when trying to lose weight?

• Skipping meals;

• Only eating those perceived “diet” foods (diet soda, low-calorie beverages and even low-calorie ice cream);

• Telling others, they are on a “diet,” rather than saying something like “I’m really trying to change my eating patterns and behaviors.”

We need much more of a balance with our eating. There are no “good” foods and “bad” foods. For example, patients always think potatoes, corn or peas are “bad,” and they shouldn’t eat them. Registered Dietitian Nutritionists understand the science of food, and teach consumers why that is just not true. What is the impact of obesity on the economy and worker productivity? It costs upwards of $210 billion per year. Obesity is a chronic condition that is usually accompanied by other co-morbidities, such as hypertension, diabetes, heart disease. Obese children have greater school absences, and if those children need to be taken to the doctor or stay home for a day, then that means parents miss a day of work. That means work productivity in the office suffers, because the employee missed a day of work. An obese adult missing work has the same effect. I have no doubt that in many cases, obesity and its complications impact families and their home life, and the work environment and the economy, as a whole. Look at our military force. Obesity is affecting recruiting eligibility, and possibly job performance in troops protecting our country. In the college class I teach, we also discuss obesity rate in Emergency Responders (i.e., policemen, firemen, EMTs, etc.). Running, climbing ladders, carrying oxygen tanks may be harder when the responder is obese. Should overweight people pay a higher premium for their health insurance? Do you think they will in the future, based off of recent health care proposals? I cannot say that overweight people should pay a higher premium for health insurance. Obesity is a very complicated, multi-faceted disease. In fact, there are some obese individuals that are living normal, healthy, productive lives. I just do not believe we have the disease of obesity figured out yet to the extent that would warrant a higher health insurance premium for all such individuals. Melissa Halas-Liang Media Representative for the California Academy of Nutrition and Dietetics What are some tips for eating healthy without breaking the bank? Eating healthy really comes down to eating whole foods that are closest to nature. Foods like legumes (beans, peas, lentils, nuts, etc.) to get adequate fiber in your diet, and eating colorful fruits and vegetables like dark berries, apples, avocados, tomatoes, spinach, kale, broccoli, etc. to get the necessary vitamins and minerals in your diet that help our body make energy efficiently and keep our immune system strong. Additionally, keeping meat portions to quarter of the plate and making them lean meat choices to keep saturated fat low. If you make animal protein the compliment to a meal instead of the center stage, it can help keep food costs on target. I keep frozen blueberries, mango, string beans and edamame in my freezer as staples -- and rotate between frozen and fresh fruits and veggies to stay on budget. If I’m making ground beef, I’ll add in chopped Portobello mushrooms or kidney beans to add bulk. It’s a great way to stay on track with calories, too. I also buy certain foods in bulk, like sweet potatoes, quinoa, brown rice at membership food clubs. Buying staples in bulk (that you don’t over-eat) can save money and avoid food waste. Then aim to bulk cook every few days or twice a week so it’s not’s overwhelming. Then you switch up how the food you prepared in bulk is served, for example for sweet potatoes, you may serve mashed sweet potatoes, sweet potato nachos or sweet potatoes topped with hummus and Greek yogurt over the course of five days. Try using a slow cooker to make inexpensive cuts of meat taste great -- because the cooking time tenderizes. Using a slow cooker is one of the best ways to save money and eat healthy. It allows you to cook in large batches, which will give you leftovers for a few days, avoiding high-priced convenience lunches. Try making a largely mixed vegetable quiche on Sunday that will give you a healthy and tasty breakfast for several days. Eggs are relatively inexpensive, and you can use frozen vegetables to put in the quiche. What are the biggest mistakes people make when trying to lose weight? Most often, I hear clients and friends choosing a fad diet their friends or social media swear by. These diets aren’t sustainable; people lose touch with the enjoyment of food and what it means to nourish your body. You can eat healthily, have balance and have it taste good, too. That’s why working with a registered dietitian nutritionist can help. Keep in mind, all registered dietitians are nutritionists -- but not all nutritionists are registered dietitians, so look for the credential RD or RDN. A majority of the time, successfully losing weight and keeping it off requires long-lasting behavior change. Small healthy, sustainable and realistic habits need to be built on so you create a healthy foundation. Just like you map out how to get to work, you need to map out the foods you’re going to eat. Planning for good eating habits and exercise takes time and effort, just like everything else in life. But once it becomes routine, it’s easier, not as overwhelming. The benefit is you feel better, too. What policies should government pursue to combat obesity and reign in the cost of healthcare? Make visits to a registered dietitian covered by insurance for people, before they’ve hit the obesity mark or worse, life-threatening co-morbidities. So, for example, cover three or four visits to a registered dietitian each year throughout the lifespan, and possibly offer health care incentives, like rebates at the end of each year for actually visiting the Registered Dietitian and maintaining a healthy weight. With childhood obesity being far from abated, implementing policies that focus on access to affordable preventative health care services will be key to reducing future health care costs. The Centers for Disease Control and Prevention reports a new all-time high for childhood obesity, at 17.2 percent of youth ages 2-19 between the years of 2011-2014. A 2014 meta-analysis of research on the lifetime medical costs related to childhood obesity revealed an estimated $16,310-$19,350 in incremental lifetime medical cost of an obese child, compared to their counterpart who maintains a healthy weight throughout their lifespan. Estimates of incremental lifetime medical costs provide a benchmark of the potential per capita savings that could be accrued from obesity prevention and treatment efforts. If current obesity trends continue, by the year 2030 annual medical costs for treating obesity and its related disorders are projected to rise by $22-66 billion each year. Obesity in teenager years is known to increase the risk of certain types of cancer. In addition, kids as young as five who are overweight or obese already have risk factors for heart disease. Early intervention through policy and creating new social norms are essential. What is the impact of obesity on the economy and worker productivity? Obesity is not a lone traveler when it comes to health risks. As someone becomes obese, they’re also increasing their risks for and will likely develop some of the co-morbidities that come along with it: cardiovascular disease, type 2 diabetes, and certain types of cancer. In fact, a 2002 study found that obese individuals had a 67 percent higher chance of developing a co-morbidity like diabetes than their healthy-weight counterparts. Although it is hard to estimate the true impact of lost productivity (also known as presenteeism) in the workplace related to obesity, a 2010 study reports estimates between $322 for overweight to $6,087 for grade III obese men. For women, the study reports estimates between $797 for overweight to $6,694 for grade III obesity. On an absolute basis, the estimated costs of lost productivity related to obesity for full-time employees is around $73.1 billion per year. These costs are ultimately passed down to the employee through higher premiums, co-pays, and deductibles for medical services. Therefore, we need to empower people to take care of their health through eating a healthy diet that tastes great and to move more. Once they feel the physiological benefits, they’ll have time to notice the financial benefits as well. Should overweight people pay a higher premium for their health insurance? Do you think they will in the future, based off of recent health care proposals? This is a tough question, because as technology advances, so does our knowledge of how our bodies work, and particularly how our bodies function in relation to their environment. When talking about this physiologically, this is called epigenetics, which is ultimately the combination of our biology plus the environment around us. Things like stressful life events and environmental toxins can “mark” our genes and cause altered phenotypes (or expression) of genes. It’s been referred to as “life-in-the-making,” as these marks do not cause changes to the DNA sequence, but can, in fact, create a change in our phenotype within a matter of decades (i.e., within the span of our own life). This has given rise to the debate of whether obesity is solely the responsibility of the individual, or perhaps out of their control due to physiological factors. Additionally, we know that obese children have a very good chance of being obese adults. That begs the question, who bears the responsibility in these cases? The obese child who then grows into an obese adult, or the parent who might not have done all they could do to prevent their child from becoming obese? I’ve worked with overweight kids who really struggle with metabolism and genetics. They’re eating healthy, swimming and are very active and they weigh much more than a sibling or friend who eats more and exercises less. We can’t assume all overweight people have poor eating and fitness habits, just like we can’t assume a thin person eats healthy and exercises. Instead of punishing people who are overweight with higher premiums, how about providing incentives for healthier lifestyle choices? People are usually motivated by hearing more positive messages, such as eat more of these healthy foods, then avoid this long food list. Mary Cluskey Associate Professor of Nutrition, Dietetic Internship Director, and Director of the Healthy Foods and Diet Core for the Moore Family Center for Whole Grains and Preventive Nutrition at Oregon State University What are some tips for eating healthy without breaking the bank? Food costs represent about 10-12 percent on average of consumer disposable income; with about half going to food away from home, and slightly less than half going to foods at home. Saving on food spending involves planning for meals and eating, which includes projecting foods to be consumed during some period of time (like a week) and getting ingredients by shopping infrequently, going by your planned list. It is easiest to save on food when preparing food at home and for more than one person, but planning what to eat generally helps manage costs. Food away from home that is healthy is not more expensive than eating food which is unhealthy. But, caloric density (explained below) of food away from home is about 2.4 kcal/gram, and food at home is about 1.8 kcal/gram. It is true that healthy foods like fruits, vegetables and whole grains can be expensive. Fresh fruits and vegetables can be costly when out of season and/or organic. They are also costly in that they may spoil before they get consumed, and then go to waste. Minimally processed, plain (e.g., no sauces and less sodium), frozen and even (some) canned can be better buys, as they have no trim loss and they will not spoil before you eat them. People think that fresh is always healthier, but the evidence does not support that. Nutrients can be very similar and even better in the processed (frozen and even canned) products, as they are processed at harvest and optimal quality. But, to answer the question, less expensive fruits and vegetables include: apples, bananas, oranges and grapes in season, carrots, cabbage (great long shelf life, better than lettuce, as has more nutrients), potatoes, and dried beans. To save money on grains, we should consider the recommendation that half our grains should be whole grain -- whole grain breads can be expensive, but whole grain cereals are less expensive (e.g., oatmeal); whole grain brown rice is not. Dried beans (and again canned, as you can reduce the sodium somewhat by rinsing) are also very inexpensive. Selecting those grains that are whole grains, but preferred sources (e.g., most liked) should be the ones to focus on, and establish a balance between cost/preference in relation to meeting the “half grains as whole grain” recommendations. Saving money comes down to preparing, planning and carefully choosing, which takes time, and we hate to spend our time more than to spend our money. There are several other answers to this question for multiple reasons, which have to do with defining “healthy” and perceptions about cost. The first is that cost is really about perceived value, and people accept higher costs for foods that they think are worth it. So, for example they might complain that an apple costs too much, but willingly pay for Odwalla juice a price three times higher, which has less fiber, fewer micronutrients and more sugar. Another is about the perception that ingredients (chemical names that they don’t recognize) and products labeled “natural,” or which are local or organic (or other characteristics) define health. In the world of nutrition professionals, we don’t ignore the value of less processed foods and local ingredients, but we define health as being a function of nutrients and calories. Mostly, we are concerned about energy density, defined as calories/gram weight (or serving) and nutrients/calorie. If you eat a high-calorie food, you should be getting sufficient nutrients (vitamins and minerals) proportionate to those calories. A 3-oz. serving of high-quality beef (steak) might have 21 grams of protein, and 15-20 grams of fat, but it also has a rich nutrient profile for those that are difficult to get, e.g., vitamins B12, B6, zinc, iron, and others. So, for the 268 calories, you get several other nutrients. A donut easily provides the same calories (and trans fats), but offers very few nutrients and a lot more sugar in comparison. People will get hung up on the saturated fat in the meat, with disregard for the other nutrients. Eating those foods in portions that are recommended amounts (2-3 oz. for meats) is a reasonable trade-off of consuming some fats (but still within recommendations), but getting difficult nutrients that are hard to get in the diet. Better feeding practices is improving the fatty acid profiles (e.g., healthier fats) in meats. What are the biggest mistakes people make when trying to lose weight? People treat weight loss and dieting like an event with a start and end. That makes it impossible to really build it into one’s lifestyle. There are a variety of ways that it can be managed better, by establishing a few patterns or rules and sticking with it. People who exercise or get activity on a regular basis don’t find it difficult to find the time to stick with that habit. That is because it becomes routine. Eating is the same way. Here are some ideas.

• For appetite, Barbara Rolls’ work shows that foods with low energy density (usually means high in water, salads, vegetables, fruits, even oatmeal, soups – clear, like vegetable, better than chowders, etc.) give a sense of satiety, and one may eat less if they begin a meal with a food such as that.

• Make rules for oneself -- I only allow myself to eat one snack/dessert/ “unhealthy” food a day. I mentally tell myself that I can eat another choice tomorrow. If I have a day where somehow, I ate more than I wanted, I make the next day an “eat less” day.

• Other possible behaviors -- never eat after dinner; never eat between meals out of whimsy or unexpectedly. Always eat breakfast. If you go to a party, try one of the “unhealthy” appetizers (or very small portions of 1-2), but be generous on the celery, carrots, grapes or whatever lower energy density foods are available. Avoid the chips, crackers.

• When actively trying to lose weight, the evidence shows that keeping track of what you eat (mentally, on a device, a notebook, or just thinking about it) and being accountable to someone with whom you weigh in makes you mindful of thinking about what you are eating.

What policies should government pursue to combat obesity and reign in the cost of healthcare? The cost of health care is a complicated and expansive topic. I don’t think health care should be a for-profit enterprise. I am not sure I would advocate for higher premiums for obese subjects. Poor health and obesity are both associated with lower SES. So, if charged more, it would cost more for Medicaid; for people who have to buy their own insurances, they would likely not. Then, they would still cost more as they would go the ER instead of prevention. I think, unfortunately, the only way to improve the situation is to try to work with children and change the dynamic. It is the value of health that they may not learn early. That would mean putting some life skills back into school (e.g., budgeting and cooking, child care training). The evidence on advertising and obesity (and thus a policy such as that) does not indicate a direct relationship. There is a great review, probably a little dated now, by Brian Wansink and another marketing expert, Is Food Marketing Making us Fat? I also don’t have an objection to limiting the kinds of food (although, this could be a mess if we start) one can buy. Particularly sugar sweetened beverages (pop, energy drinks; I do not like us including 100 percent fruit juice, as it is crazy to think natural sugars are unhealthy). Lydia Kret Lecturer in the Dietetics and Human Nutrition Program at Eastern Michigan University What are some tips for eating healthy without breaking the bank?

• In season local foods are always a good bet. Fresh from the farmers’ market with good prices.

• Use store brands. They are generally less expensive, but still of good quality.

• Frozen items can be a good buy. You can use the portion you need and put the rest back in the freezer. So, you are only using what you need at that particular time, no waste.

• Cook to have leftovers; you can consume them that same week, or you can freeze and use later.

• Take advantage of your freezer space. If there is a good buy at the store for items you use (such as frozen vegetables), buy the maximum quantity while they are on sale and freeze.

• If you are able, plant some of your own food. Tomatoes are fairly easy to grow; you can even grow them in a pot if you don’t have a yard. You can eat them fresh, you may can them, you can freeze them and make sauce or salsa, or you can make chili or spaghetti sauce and freeze for use throughout the non-growing season.

• You can have a “meatless” meal at least one time per week. This can cut back on use of expensive meats.

• You can buy less tender cuts of meat (generally less expensive), and use a crock-pot to cook for a longer period of time to help them tenderize.

• If you are able to swing it, you can buy quantity meat from a butcher (such as half a cow), this can be less expensive and it will freeze well.

• It’s generally less expensive to purchase foods in their whole form and prepare them at home. So, in other words, buying whole carrots as opposed to the baby carrots which are already cut can help with budgeting. Just be sure to prep these foods as soon as possible upon returning home from the grocery store. Otherwise, they may not get prepped and used and then you might have been better off buying the already prepped carrots/vegetables.

Other ideas:

• Using coupons for the items on your list can help with your budget.

• Utilizing the store flyer to plan your meals ahead of time can also help; you can take advantage of sale items that you and your family will eat.

• Make a list and stick with it. Planning your meals ahead of time and only buying what you need will help you stay within your budget.

• Things everyone has heard -- don’t go to the grocery store hungry; the less times you stop and shop, the more money you will save, or in other words, the more times you stop at the store per week the more money you spend.

• Utilize a wholesale club and purchase in larger quantities. As long as the shelf-life and freezer ability are there, you can save money.

What are the biggest mistakes people make when trying to lose weight? Everyone wants the quick fix, and that is not how it works. It is a lifestyle change that incorporates many things, including food intake, physical activity, sleep, etc. “Diets” can work well at the beginning, but it’s the long haul you need to think about. Ask yourself -- can I live with this the rest of my life? Am I enjoying what I eat? Am I living to eat or eating to live? If the answers are not what you want to hear (such as no, I can’t live with this the rest of my life), then it’s probably not for you, and won’t work in the long run. One of the things I see is people who think that if they skip meals, they will lose weight. You need to eat to manage your weight. Our bodies are made to survive. So, skipping meals and eating very low-calorie diets will cause the body to think it is in a famine, and it will adjust by using fewer calories for the same job. Cutting out one food group is not the way to go. Your body needs all food groups, including grains, meats (or meatless protein), fruits, vegetables and dairy. While cutting out a food group generally means you are consuming fewer calories, you are not getting all the vitamins, minerals, potential macronutrients, fiber etc. for your body to work its magic. Your body is a machine that operates in a very methodical way, and to keep it in working order, you need all food groups. People think their portion size is correct, when in reality, they are consuming more than they think. Measuring food is a good idea when trying to control portion sizes. Using single-portion items can help, but tend to be more expensive. So, it behooves you to weigh and measure food for accurate portion sizes, at least to start. Then come back every now and then and do it again, so you continue to know what a serving size looks like. Kent Adams Department Chair and Professor of Kinesiology at California State University, Monterey Bay What are some tips for eating healthy without breaking the bank? Invest in a reusable water bottle and drink water. Cook quality meals in advance (lean meats, veggies, fiber) and separate them into containers to take to work for lunch; doing this a few days a week is healthier and less expensive than eating out. Skip organic; it is simply more expensive with no significant health benefit. What are the biggest mistakes people make when trying to lose weight? A healthy lifestyle is a marathon, not a sprint. Real change takes time and dedication. Commit to the long haul; focus on positive change, not weight. Start to think of your food as fuel; make the connection of balancing calories in and calories out. Pay attention to the caloric content of snacks, alcohol, etc. Incorporate physical activity and exercise that you enjoy, and therefore will stick with. Don’t go it alone; the social aspect of exercise provides additional benefits. What policies should government pursue to combat obesity and reign in the cost of healthcare? Policies such as the Physical Activity Recommendations for Americans Act and supporting funding for scientific investigations, such as those promoted by the NIH and the American Heart Association are crucial in this battle. Physical activity and eating patterns are influenced by a wide range of factors, from individual to community and institution-based. Policies must attempt to be comprehensive, but ultimately, the “individual” is in control of their daily behavior. Sedentary lifestyles are killing us. Do you choose to sit or get up and move? Do you choose to eat better or choose the high-calorie option? Health care is complicated, and policies related to prevention, education, access and affordability of a healthy lifestyle are crucial; but in addition, when you look at the individual and societal costs of sedentary lifestyle and obesity, it is time to turn the mirror on ourselves -- it is time to move. What is the impact of obesity on the economy and worker productivity? One example of cost would be to simply refer to the American Heart Association’s projection in a 2017 report titled “Cardiovascular Disease: A Costly Burden for Americans -- Projections Through 2035” which states that in 2016, cardiovascular disease cost America $555 billion, and this cost will rise to $1.1 trillion by 2035 -- which includes $368 billion in indirect costs due to lost productivity. Cardiovascular disease is dramatically impacted by poor lifestyle choices (e.g., sedentariness, unhealthy eating, obesity, etc.) that often begin early in life. Change must start with the individual. Should overweight people pay a higher premium for their health insurance? Do you think they will in the future, based off of recent health care proposals? Rather than punishing those who make poor choices, perhaps rewarding those who make positive lifestyle choices is the path to a healthier future. Rewards with accountability (e.g., help with gym memberships for those who use them; building walkable, safe communities; providing access to low-cost, healthy foods; providing education on healthy lifestyles; supporting science literacy; focusing on prevention; etc.) may be the more appropriate strategy. But if we fail to make positive changes in lifestyle, one may anticipate health insurance premiums to continue to rise. Joseph A. Skelton Associate Professor of Pediatrics at Wake Forest Baptist Medical Center What are some tips for eating healthy without breaking the bank? Learning to cook and meal-plan are the biggest factors. It takes some practice and skill to put together meals you like that are healthy, but it works. Sweet potato black bean chili is delicious, fairly easy to cook and can feed a family of four for about $12. Learning some techniques to cook at home is one of the best ways to eat healthy and on the cheap. What are the biggest mistakes people make when trying to lose weight? Not recognizing how our environment influences what we eat and drink. We make nearly twice the number of calories -- per person per day -- a person needs in the U.S. So, there is a lot of pressure on us to buy and consume that food. Knowing that is empowering, and you can schedule your life to avoid that pressure. Finally -- the biggest mistake is doing a fad diet, then when the weight loss stops, going right back to what you were doing before. What policies should government pursue to combat obesity and reign in the cost of healthcare? We need to make being healthy easier and cheaper -- so, subsidizing the growing of healthy foods. But probably the biggest step is setting policies that make our environment a little healthier, including our schools, grocery stores, restaurants, etc. It’s easier to be unhealthy than it is to be healthy, so systematically identifying the unhealthy areas in our environment, and without robbing people of choice and freedom, set up ways that make the healthy choice the easy choice. What is the impact of obesity on the economy and worker productivity? We know that health care costs are high, and obesity costs us as much as $160 billion a year, and it’s only getting worse. That is draining the economy. Also, as our health declines with rising obesity, that impacts our ability to work, decreasing productivity. It contributes to absenteeism from work, be it when you are sick or having to go to doctor's appointments. There is also presenteeism, when you are not sick but are worried about a family member that is sick, so you aren't as productive at work; or when you might come to work sick but are not as productive. So, it’s a huge issue for our work productivity, both in how productive we are, as well as health care costs. Should overweight people pay a higher premium for their health insurance? Do you think they will in the future, based off of recent health care proposals? Should overweight people pay a higher premium for their health insurance? Do you think they will in the future, based off of recent health care proposals? I don’t think so, because someone could be overweight on a scale, but healthier than someone of normal weight. I know plenty of people that fit that description. Also, losing just 5 percent of your weight can result in huge improvements in health, even if the person is still overweight. It’s proven that using a "stick" to get people to be healthier doesn't work -- we need the "carrot," providing services (in our doctor's offices, schools, worksites, etc.) that help people be healthier, as well as changing our environment to make it be easier. Jonathan Valdez Public Policy Coordinator and Co-Chair of the Greater New York Dietetic Association, New York City and Long Island Media Representative at New York State Academy of Nutrition and Dietetics, and Online Professional Development Coordinator at the National Organization of Men in Nutrition What are some tips for eating healthy without breaking the bank?

• If you’re on a strict income, meal-planning is the best way to save money. This includes being mindful of the fruits and vegetable in season, couponing on foods, finding things that are on sale. If you’re unsure, make easy things that you can put in stir-fries, soups, omelettes.

• Always plan your meals from shopping to cooking, to making leftovers. On average, Americans throw out about 25 percent of all food and beverages purchased. On a fixed income and a family of four, that could be about $1,365 to $2,275, annually. This study by Natural Resources Defense Council was done in 2012 -- it could be more now.

• Consider portion sizes and saving money. When you eat a 3-ounce steak, which is a proper serving of protein, versus a 6-ounce one, which is double and overconsumption, you find yourself cutting the cost by half. After that, you add a bit more fruits, vegetables, grains, and a dairy -- then you find yourself eating a balanced meal without throwing money away.

• Consider not purchasing perishable goods in bulk, unless they can be frozen. Many times, foods like this may end up in the trash. Or if you purchase in bulk, make sure it can be frozen.

• If you’re on a budget, refrain from purchasing organic, which is marketed as “healthier” and “safer” than its non-organic counterpart. Purchasing organic broccoli versus non-organic broccoli, meat, etc. doesn’t mean it’s safer. It goes through the same rigorous regulations for food safety and contain virtually the same nutrients. The difference is how it is grown.

• If you’re more affluent but still on a budget, when eating out consider halving the portion sizes and take the other half for lunch the next day.

What are the biggest mistakes people make when trying to lose weight?

• Zero to no carbohydrates -- carbohydrates are the primary source of energy and prevent muscle breakdown (protein). In addition, they assist with the metabolism of fat. The grander scheme of things is total caloric intake, whole grains, and high fiber.

• Skipping meals -- people think that skipping breakfast (most common) or any other meal is going to help them lose weight. In the short run, it may, but the body is adaptable and when you begin skipping meals, the metabolism begins to slow down. Once that metabolism slows down, it will be even more difficult to lose weight as compared to eating three balanced meals and exercising, regularly. Furthermore, this could lead to undernutrition whether you appear “healthy” or overweight/obese.

What policies should government pursue to combat obesity and reign in the cost of healthcare?

• By asking your Senators and Representatives to co-sponsor the Treat and Reduce Obesity Act or TROA (H.R. 1953; S. 830), which requests more funding and better treatment options for health care professionals, including Registered Dietitian Nutritionists. This will expand interventions, counseling, and drug treatments.

• Supporting the reauthorization of the Farm Bill, which reauthorizes two effective nutrition education programs: SNAP Nutrition Education and Obesity Prevention grants (SNAP-Ed) and the Expanded Food and Nutrition Education Program (EFNEP). These two programs assist with nutrition education in order to make healthier choices.

• Preventing Diabetes in Medicare Act (H.R. 3124/S. 1299), which expands care for Medicare recipients and reduces health care costs associated with diabetes.

• Helping low-income and underserved areas receive the same benefits and access to adequate grocery stores, education and safety as anywhere else.

What is the impact of obesity on the economy and worker productivity? People who are obese with a BMI above 35 are typically the people who will have the greatest health-related work limitations, especially if it requires physical demands. As of 2008, the annual medical cost of obesity in the U.S. was about $147 billion, due to 42 percent higher medical spending per capita. This in comparison to Germany in 2008, where they only spent $9.2 billion. It’s difficult to determine the true cost of being overweight and obese -- it has to be analyzed on an individual level compared to the job that is being requested, but it does show that there is increased use of sick leave, disability and, depending on the wage, there can be a loss as small as $6 per hour or as high as $500 a day. Should overweight people pay a higher premium for their health insurance? Do you think they will in the future, based off of recent health care proposals? The higher premium for health insurance isn’t a solution, it is more of an attack. We need an inclusive approach. For example, have a baseline for healthy, obese, overweight, etc. Perhaps check metrics such as cholesterol, blood pressure, attendance to the gym with signature, attendance and progress notes from a Registered Dietitian Nutritionist, blood sugars, HgbA1c, etc. If there are quarterly improvements, there shouldn’t be an increase in premium. For healthy people, maintaining that healthy status will keep them at that premium. Or if there is a high premium, if improvements have been obtained, then there should be a premium decrease. Hopefully, this would assist with making better behavior changes. Elizabeth Larson Associate Professor with the Department of Kinesiology's Occupational Therapy Program at the University of Wisconsin-Madison School of Education What are some tips for eating healthy without breaking the bank? Local farmers’ markets are a great resource for getting healthy produce that is fresh. When that’s not possible, flash-frozen fruits and vegetables are equally healthy. For our students on campus, we have a “food shed” that provides free leftover produce from local and campus gardens. All communities need these kinds of resources. We need to assure that food deserts, places where grocery stores and fresh produce are not centrally located or reasonably priced, are eliminated. What are the biggest mistakes people make when trying to lose weight? Most often, people start with changes that are too ambitious and then, when they make a misstep, they give up. Being honest with ourselves about what we can do -- what will fit in our daily life -- and what we want to do (avoiding the “shoulds”) can allow people to be more successful. In all of the lifestyle change projects my students have done in my Living Well course, there is a small group who choose to and are able to “will the change” into their life, but most people need some accountability and social support. This accountability needs to be someone checking in, who does not make their lapses the key focus, but who supports how to go forward from there. In addition, each person's goal needs to be a clear target that can be tracked, reasonable, and tailored to fit in his or her life. What policies should government pursue to combat obesity and reign in the cost of healthcare? Funding prevention is really important; this should include interventions in primary care or as part of a visit with the primary care physician. It may not be that the doctor should be the lead in lifestyle change, but there should be an expert on lifestyle change, such as an occupational therapist, that can work with people to make health promoting changes. Few people want to be obese or otherwise unhealthy, but as Kegan’s "Immunity to Change" work points out, staying the same has its upsides, as does change. It’s often not that people don’t want to change, but they need the tools and support. In my view, this goes beyond the educational model, but must be a strategic lifestyle intervention that considers an individual’s desires, resources, daily routines, habits and even circadian rhythms. Given that chronic conditions require a substantial portion of the health care budget, the shift to prevention will be a major policy change. NIH is funding behavioral lifestyle change projects in this effort, to find programs that are effective and promote sustainable health change. Should overweight people pay a higher premium for their health insurance? Do you think they will in the future, based off of recent health care proposals? This question is the proverbial slippery slope. It assumes that obesity is a choice and thus, if you choose to be obese, you should pay more. Can the same be said for smoking, cancer, genetic autoimmune disorders and so on? Given the new research suggesting that gut flora may be related to weight (flora transplants leading to dramatic weight changes) and that genetically personalized diets may lead to better weight loss, I think we need to toss out the “calories in/calories out” thinking about weight for something more complex and nuanced. Similarly, while exercise is being recognized as medicine due to its positive influence on mood and physiology, some people are genetically predisposed to benefit more than others. We are entering an era of personalized medicine, where it seems like we will be able to move from a one-size-fits-all approach to one that designs interventions that work best with who we are. This, as the future of health care, would allow us to better allocate health care dollars to prevent rather costly chronic conditions. Bhimanagouda S. Patil Professor of Horticulture & Director of the Vegetable and Fruit Improvement Center at Texas A&M University What are some tips for eating healthy without breaking the bank? Cooking at home, healthy seasonal food rather than adding energy consumption to store, explore a variety of local foods. What are the biggest mistakes people make when trying to lose weight? Lack of maintaining a systematic approach. Eating without being hungry, eating junk food at odd times without providing a gap between sleep and last meal. What policies should government pursue to combat obesity and reign in the cost of healthcare? Government should encourage more produce and invest money in healthy food research. If fruit and vegetable consumption increases to 400-650 grams per day, we could potentially save $2,000 per person each year in health care cost by reducing risk for several diseases, including heart disease. What is the impact of obesity on the economy and worker productivity? Obesity significantly affects working habits and productivity. Eventually, obesity-related diseases such as cancer, cardiovascular disease and diabetes will have a significant negative impact on the economy. Should overweight people pay a higher premium for their health insurance? Do you think they will in the future, based off of recent health care proposals? Currently, it may be better to focus on preventing obesity and reducing risk from obesity-related diseases, rather than developing differential health plans. This may not solve the root cause of the disease. In the future, it is likely that premiums will go higher. Amanda Arguello Morris Adjunct Faculty in the Health & Wellness Program at Tulane University What are some tips for eating healthy without breaking the bank?

• Prepare meals and snacks at home utilizing the most basic ingredients: fruit, vegetables, whole grains (oats, rice, quinoa, etc.), nuts, seeds, and beans. Even fruits and vegetables that are pre-washed or pre-chopped are considered somewhat processed and will have an increased price. Remember, one will always pay for convenience.

• Limit meat and dairy products. Meatless Mondays and vegan/vegetarian meal options are becoming more available in restaurant chains, and even convenience food outlets. One can usually save a few dollars, whether at the grocery or an eatery, by choosing a meatless option. Ensure you incorporate some plant-based protein sources to maintain fullness, including beans, nuts, and seeds. You’re also promoting heart-healthy eating by reducing the animal products and incorporating more high-fiber foods.

• Prep, portion & repeat -- plan to overcook. If you’re open to eating leftovers, double a recipe to provide lunch meals for the week, or just a few freezer meals for those desperate times. Portion meals out in appropriate one-serving sized containers to manage your energy intake and stretch your meals.

• Shop local, seasonal produce. Try your local farmers’ market for extra fresh ingredients. Incorporate frozen fruits and vegetables, which are typically cheaper than fresh produce, where you can, such as soups, stews, smoothies, and casseroles.

• Shop with a plan. Determine at least three dinners for the week, as well as two options for lunches and breakfast before you grocery shop. This will help to avoid adding random items to your cart or leaving with bags full of grocery, but nothing that constitutes a balanced meal. If you like to snack, limit yourself to three snack options for the week -- try to incorporate grab-and-go fruit or vegetables.

What are the biggest mistakes people make when trying to lose weight? Over-restriction. Oftentimes, people try to make drastic changes that are not realistic and not sustainable, which leads to failure. The best way to create long-lasting behavior change is to incorporate small, gradual changes that become habits. Don’t fall for the gimmicks or trends. There’s no magic pill. You will have to incorporate a combination of nutritious eating habits, reduced calorie intake, and regular physical activity to achieve and maintain weight loss. Consult with a dietitian or health expert to find the most appropriate weight loss approach and develop a strategy that focuses on specific behavior change solutions. What is the impact of obesity on the economy and worker productivity? Obesity is often a precursor to or associated with many chronic conditions, including type 2 diabetes, heart disease, sleep apnea, and more. What’s concerning is that obesity is increasing in our younger population -- our current and future workforce. While the price of obesity may not seem costly to the younger population, it’s the complications of carrying excess weight over time that becomes a costly burden. As we know, prevention is key. Just as we know stress impacts employee productivity, so does health status. Increase in doctor visits and sick days leads to increased employee absenteeism, which impacts overall productivity for an organization. Thus, the increase in corporate wellness programs aimed at improving population health to manage increasing health care claims cost and manage employee productivity is important. Should overweight people pay a higher premium for their health insurance? Do you think they will in the future, based off of recent health care proposals? Human behavior is a choice. People can choose to be proactive in their health by taking steps to at least be educated and improve health behaviors, if not health status. It’s difficult to validate that simply based on weight, a member should pay a higher health insurance premium, as this would be discriminatory. Many people have health conditions that impact their weight status, but may be considered “healthy” based other biometric (blood pressure) and lab assessments. Likewise, for some of these individuals, a “healthy weight” will never be attainable due to metabolic implications. It’s important to remember that weight status (normal, overweight, etc.) is based on the calculation of BMI, which is simply a ratio of weight to height and does not consider body composition or other health measures. While BMI is a basic and accessible way to assess health risk, it is in no way an overall or conclusive indicator of health. Many employees of organizations that offer corporate wellness programs are already incentivized with reduced health insurance premiums for health status or for participating in health promotion activities. It’s important that members are provided with the tools, resources, and knowledge to improve health behaviors that support achieving and maintaining a healthy weight. I don’t think we’re far off from observing consumers pay a higher health premium due to weight status, we’re basically there with many group or employer-based health plans. However, as health care costs continue to increase, it’s justifiable that healthier individuals and individuals who proactively engage in wellness behaviors to promote a healthy lifestyle and prevent chronic conditions are less likely to contribute to high-dollar claims, and thus should not pay the same premium for others who utilize more health care resources and are at a higher health risk. Methodology

In order to determine the fattest states in America, WalletHub’s analysts compared the 50 states and the District of Columbia across three key dimensions: 1) Obesity & Overweight Prevalence, 2) Health Consequences and 3) Food & Fitness.

We evaluated those dimensions using 19 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 state. For metrics marked with an asterisk (*), we calculated the population size using the square root of the population in order to avoid overcompensating for minor differences across cities.

Finally, we determined each state and the District’s weighted average across all metrics to calculate its total score and used the resulting scores to rank-order our sample.

Obesity & Overweight Prevalence – Total Points: 60

• Share of Overweight Adults: Full Weight (~6.00 Points)
• Share of Obese Adults: Double Weight (~12.00 Points)
• Share of Overweight Teenagers: Full Weight (~6.00 Points)
• Share of Obese Teenagers: Double Weight (~12.00 Points)
• Share of Overweight Children: Full Weight (~6.00 Points)
• Share of Obese Children: Double Weight (~12.00 Points)
• Projected Obesity Rate in 2030: Full Weight (~6.00 Points)

Health Consequences: 25

• Share of Adults with High Cholesterol: Full Weight (~3.57 Points)
• Share of Adults with Type 2 Diabetes: Full Weight (~3.57 Points)
• Share of Adults with Hypertension: Full Weight (~3.57 Points)
• Heart Disease Rate: Full Weight (~3.57 Points)
• Obesity-Related Death Rate: Double Weight (~7.14 Points)
• Obesity-Related Health Care Costs: Full Weight (~3.57 Points)

Food & Fitness: 15

• Share of Adults Eating Less than 1 Serving of Fruits/Vegetables per Day: Full Weight (~2.50 Points)
• Sugar-Sweetened Beverage Consumption Among Adolescents: Full Weight (~2.50 Points)
• Healthy-Food Access: Full Weight (~2.50 Points)
• Fast-Food Restaurants per Capita*: Full Weight (~2.50 Points)
• Share of Physically Inactive Adults: Full Weight (~2.50 Points)
• Fitness Centers per Capita*: Full Weight (~2.50 Points)

 

Sources: Data used to create this ranking were collected from the U.S. Census Bureau, The Child and Adolescent Health Measurement Initiative, Trust for America's Health, Robert Wood Johnson Foundation, Gallup and Centers for Disease Control and Prevention.

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