Top 5 Fattest Cities in America

Obesity is linked to many factors, including where you live

According to statistics from the Centers for Disease Control and Prevention (CDC), around 42% of adults in the United States are obese, a startling increase of almost 40% since 1999.

The obesity epidemic comes at a cost to not only individuals but to society at large, accumulating medical expenses that contribute to skyrocketing costs in the U.S. healthcare system. A 2021 study estimated that the annual medical cost of obesity is almost $173 billion.

On an individual basis, the annual medical costs for those living with obesity are $1,861 higher than for those of normal weight.

In March 2022, WalletHub released its annual list of the most obese cities in the United States. The analysis took into account a range of 19 different metrics to identify the metropolitan centers where weight-related problems call for heightened attention.

The data was sourced from the U.S. Census Bureau, U.S. Bureau of Labor Statistics, CDC, County Health Rankings, U.S. Department of Agriculture Economic Research Service, Child and Adolescent Health Measurement Initiative, Gallup-Sharecare, and Trust for America’s Health.

The following five metropolitan areas topped the 2020 list:


McAllen-Edinburg-Mission, Texas

Streets in McAllen, Texas

Denis Tangney Jr / Getty Images

The metropolitan center of McAllen-Edinburg-Mission, Texas (population 880,000) topped the WalletHub list of the most obese city in the United States.

With a score of 84.78, this Texas community ranked number one in terms of having the poorest dietary and fitness habits. This includes having the lowest daily intake of fruits and vegetables.

It also ranked sixth in the rate of overweight/obesity and fifth in the rate of health consequences due to being overweight or obese.

Consequences of Obesity

According to the CDC, people who have overweight or obesity are more likely to experience:


Memphis, Tennessee

Illuminated signs on Beale Street in Memphis

Tetra Images / Getty Images

Memphis (population 1,336,000) was the second most obese metropolitan area overall, receiving a total score of 83.94. The city has long been on the WalletHub list, having formerly been the number one most obese city in the United States.

In 2020, researchers at the University of Tennessee reported that among 462,223 adults living in Memphis, 37.2% met the clinical definition of obesity while 26.4% were overweight.

This accounts in large part for the excessive rates of hypertension (34.4%), hyperlipidemia (18%), and type 2 diabetes (14%) among Memphis residents.


Knoxville, Tennessee

Gay Street Bridge in Knoxville Tennessee USA
GreenStock / Getty Images

Knoxville, Tennessee (population 893,000) lands in the number three spot with a score of 83.92. The southern city was ranked number one in terms of health consequences of being overweight and had the fourth-highest incidence of overweight or obese residents.

What is important to note is that 19 of the 20 most obese cities on the WalletHub list are in the South. (The only exception is Youngstown-Warren-Boardman metropolitan area in Ohio at number 14.)

Studies suggest that the high rate of obesity in the South is largely linked to higher rates of poverty and unemployment.

How Poverty and Obesity Are Linked

Among the factors closely linked with obesity in Southern states are:

  • Higher rates of poverty
  • Higher percentage of the population without health insurance
  • Lower rates of high school graduation
  • Higher percentage of Black residents (who earn less than other groups)

Mobile, Alabama

Historic Downtown Mobile Alabama USA at Sunset
benedek / Getty Images

Mobile, Alabama (population 428,000) ranked fourth on the WalletHub list with a score of 83.04. Mobile had the third-highest rate of obesity overall and ranked sixth in terms of health consequences.

Obesity rates among Alabama children are of particular concern.

A 2018 study from the University of South Alabama reported that among a sampling of Alabama school children (average age 12), 42.3% were classified as being overweight or obese.

What the researchers found was that cultural dietary habits rather than socio-economic issues like poverty or unemployment influenced childhood obesity rates in Southern children.

The typical “Southern diet,” for example, is characterized by the high consumption of fried and salty foods, sugar-sweetened beverages, and red and processed meats.

This suggests that parents can play a central role in imparting healthy eating attitudes to their kids, particularly when faced with unhealthy cultural eating habits.


Jackson, Mississippi

High angle view of Jackson, Mississippi cityscape at night

Jeremy Woodhouse / Getty Images

Rounding out the top five list is Jackson, Mississippi with a score of 82.94. The capital of Mississippi’s metropolitan are (population 587,000) ranked number one in terms of the incidence of overweight or obese residents and ninth in terms of poor dietary and fitness habits.

In 2015, a startling 1.5 million adults in Mississippi were classified as being overweight or obese, according to research from the Mississippi State Department of Health.

Moreover, almost 8% of Mississippians meet the clinical definition of severe obesity, formerly known as morbid obesity. This is defined as having a body mass index (BMI) of 40 or greater.

At this level of obesity, known as Class 3 obesity, the risk of premature death is high, primarily due to heart disease, diabetes, kidney disease, lung disease, influenza, pneumonia, and obesity-related cancers (like colon cancer).

Severe Obesity and Death

Compared to normal-weight people, the average years of life lost among people with severe (Class 3) obesity increases with the body mass index as follows:

  • BMI 40–44: Average loss of 6.5 years
  • BMI 45–49: Average loss of 8.9 years
  • BMI 55-54: Average loss of 9.8 years
  • BMI 55 and over: Average loss of 13.7 years


According to WalletHub’s list of the most obese cities, the top five most obese metropolitan areas in the United States are:

  1. McAllen-Edinburg-Mission, Texas
  2. Memphis, Tennessee
  3. Mobile, Alabama
  4. Knoxville, Tennessee
  5. Jackson, Mississippi

The cities were ranked based on the incidence of overweight or obese residents, the rate of obesity-related health problems, and the dietary and fitness habits of city residents.

A Word From Verywell

Where you live can greatly influence your risk of being overweight or obese, but it doesn’t mean that you are destined to be overweight in you live in a “fat” city, Nutritional education can override unhealthy cultural dietary habits irrespective of your sex, race/ethnicity, or economic status.

There are community health services in many cities that can provide nutritional counseling and support to families at risk. Speak with your local health department to see if there are any free or low-cost nutritionist services to aid in your quest for healthier eating habits.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  3. WalletHub. Most overweight and obese cities in the U.S.

  4. Centers for Disease Control and Prevention. Health effects of overweight and obesity.

  5. Surbhi S, Brooks IM, Shuvo SA, et al. A mid-South chronic disease registry and practice-based research network to address disparities. Am J Manag Care. 2020;26(7):e211-e218. doi:10.37765/ajmc.2020.43764

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  8. Sterling S, Judd S, Bertrand B, Carson TL, Chandler-Laney P, Baskin ML. Dietary patterns among overweight and obese African-American women living in the rural South. J Racial Ethn Health Disparities. 2018;5(1):141–50. doi:10.1007/s40615-017-0351-3

  9. Mendy VL, Vargas R, Cannon-Smith G, Payton M. Overweight, obesity, and extreme obesity among Mississippi adults, 2001-2010 and 2011-2015. Prev Chronic Dis. 2017;14:E49. doi:10.5888/pcd14.160554

  10. Kitahara CM, Flint AJ, Berrington de Gonzalez M, et al. Association between class III obesity (BMI of 40–59 kg/m2) and mortality: a pooled analysis of 20 prospective studies. PLoS Med. 2014;11(7):e1001673. doi:10.1371/journal.pmed.1001673

By Yasmine S. Ali, MD, MSCI
Yasmine Ali, MD, is board-certified in cardiology. She is an assistant clinical professor of medicine at Vanderbilt University School of Medicine and an award-winning physician writer.