Despite education campaigns about the obesity epidemic and U.S. government reports that obesity numbers may have reached a plateau, a new study finds obesity rates increased in 28 states last year.
Only the District of Columbia saw obesity rates fall.
The annual "F as in Fat" report from the Trust for America's Health and the Robert Wood Johnson Foundation included obesity rates by geographic area and race as well as studies on attitudes about obesity.
"Nationally we should recognize that this problem, while it is ubiquitous, is not evenly distributed," said Dr. David L. Katz, director of the Yale University Prevention Research Center. "We should direct those efforts where they're most needed."
Researchers found obesity rates in Louisiana, Kentucky, Oklahoma and Arkansas topped 30 percent of the population last year. Previously, only four other states had obesity rates as high as one in three adults obese --- Mississippi, Alabama, Tennessee and West Virginia.
Obesity experts say a variety of factors -- from cuisine to climate to economic means -- could push the population in one state further towards obesity than another.
"In a hot sultry climate, you aren't going to be as physically active outside in Alabama as you would be in Colorado," said Dr. David Katz, director of the Yale Griffin Prevention Research Center in Derby, Connecticut. The study found Colorado to have lowest rate of obesity in the country at 19.1 percent.
Katz said considering the "obesogenic" American society, he wondered if the focus isn't on why some become obese but how others avoid it.
Given the amount of high calorie food available to Americans, and a society in which entertainment, transportation and travel encourages obesity, Katz said, "You're the odd man out if you're not caught up in all of this."
Health Magazine recently documented the nationwide culture of excess by highlighting the 50 Fattiest Foods in the States. Click here to see all 50 Fattiest Foods.
The state with the lowest rate of obesity still offered one of the most decadent foods. Colorado's Jack-N-Grill restaurant offers a giant breakfast burrito capable of feeding a family of four or more.
Fatty Food Found Everywhere -- Even in Thinnest State
The 7-pound breakfast burrito features seven potatoes, 12 eggs, a pound of ham, a whole onion, cheese and chili, according to HEALTH magazine. Two of the ingredients alone -- the ham and eggs-- have three times the daily limit for fat.
Montana ranked 43rd on a list in which 50th has the least amount of obesity and the 1st spot goes to the state with the highest rate of obesity.
Yet this mountain state had fat-focused cuisine as well. HEALTH magazine featured the infamous prairie oysters, otherwise known as calf fries or Rocky Mountain oysters.
The magazine claimed its "hard to pin down nutritional information" on the deep-fried calf testicles. But the recipes often call for salted water or buttermilk, vegetable oil or lard. HEALTH magazine estimates the deep-fried batter alone is worth at least 5 grams of fat.
Is Local Cuisine All to Blame for Obesity Epidemic
Still, other experts say local cuisine in combination with other factors can have an influence on which states are more obese than others. For example, nine out of the 10 states with the worst obesity rates are in the South.
"One thing in the South, most of the time when you order tea you get sweet tea," said Dr. Howard Eisenson, director of the Duke University Diet and Fitness Center in Durham, N.C.
"It's part of the culture here, to have sweetened beverages," he said. "If you go north of the Mason-Dixon Line and order tea, you'd have to specify whether it's iced tea and even whether it's sweetened."
In one study cited by the report, parents seemed to be clueless about the childhood obesity problem. While 84 percent of responding parents in a survey of 1,200 registered voters thought their children were of a "healthy weight," nearly a third of all children are obese according to the study.
Image of Normal Weight May Be Skewed in America
Eisenson said it is yet another indication that our nation has a pervasive problem that has even changed our perception of what the average weight looks like.
"There was a time you could drive around Durham and be pretty accurate if you could guess that someone was on a weight loss program," said Eisenson. "It probably is more challenging today."
North Carolina's fattiest feast is certainly unique and chock full of cholesterol, according to Health Magazine. Meet "Livermush," then feel free to put it in omelets, on pizzas or anywhere else you desire. Made of assorted pig parts -- usually 30 percent liver -- cornmeal, pepper and salt, one serving packs about 30 grams of fat.
Nearby neighbor Georgia and Kentucky also had some original food on HEALTH magazine's list.
Georgia's so-called "Luther Burger" combines all the fat of breakfast and dessert with the all-American hamburger.
Ingredients include a ground-beef patty, cheese, bacon and occasionally an egg between two glazed doughnuts instead of a bun. Forget the cheese, bacon and the egg, and the Luther Burger still packs 40 grams of fat.
The rest of America does not have to travel to try what HEALTH magazine dubbed the fattiest food in Kentucky. The new Double Down bun-less sandwich from KFC is available across the nation. With two fried chicken fillets, bacon, two kinds of cheese and "special" sauce, diners can also down 32 grams of fat in one sandwich.
While many southern states currently rank high in obesity rates, experts say all states are at risk for increasing their numbers if local governments don't take public health measures to prevent obesity.
"All things being equal the average person is going to get fat in the modern world," said Katz, who said he hoped the state-by-state comparisons motivated some of the lowest ranking states to make a change. But, he said, rates in some least obese states are still far too high.
"State-by-state reports are helpful in recognizing how the epidemic continues to grow, but it fails to capture the much greater intensity of the problem in certain communities -- places where there are environmental and social barriers to healthy eating and physical activity," said Dr. George Flores, program manager of The California Endowment, a private health foundation in Oakland, California.
The Associated Press contributed to this article.