Weight Worries: The US States Affected Most by Obesity, Insufficient Sleep, and Anxiety Disorders
Key highlights
- Ohio has the highest combined levels of obesity, insufficient sleep, and anxiety disorders, making it the least healthy state by composite score in our ranking.
- Southern states dominate the obesity rankings, with all of the top five located in the Deep South or Midwest.
- Anxiety disorders are most prevalent in major coastal and Western states, where urban pressures and high living costs may be contributing factors.
With obesity, anxiety, and poor sleep now affecting millions across the US, the toll on physical and mental well-being is growing rapidly. According to the CDC, over one-third (33.8%) of American adults live with obesity, with even greater numbers (36.3%) reporting chronic sleep deprivation. These are two conditions closely intertwined with mental health, leading to a situation where we’re seeing all three rising together.
Despite widespread awareness of wellness culture, from the rise of fitness apps to growing interest in diet and mindfulness, the figures reveal a worsening national picture. To understand where these challenges are most acute, NiceRx analyzed recent data on obesity, insufficient sleep, and anxiety disorders across all 50 states.
With these insights, we can better grasp the scale of America’s well-being challenge and spark meaningful conversations about the need for holistic approaches, from lifestyle changes to medically supported weight management with drugs such as compounded semaglutide.
The US states that are most affected by obesity, insufficient sleep, and anxiety disorders
New analysis from NiceRx reveals the U.S. states facing the greatest overlap of physical and mental health challenges. By combining rates of obesity, chronic sleep deprivation, and anxiety disorders, the findings paint a picture of where Americans are struggling most with well-being, and where public health efforts may need to focus next.
The data shows a clear pattern: Midwestern and Southern states dominate the top of the rankings, with Ohio, Louisiana, and West Virginia recording the highest combined scores. In each, obesity and sleep deprivation affect roughly four in 10 adults, while close to one in five live with anxiety disorders.
These overlapping burdens reinforce the links between physical and mental well-being, with factors such as economic strain, poor sleep, and limited access to health resources compounding over time to have a holistic impact on individuals.
| Prevalence in adults | |||||
|---|---|---|---|---|---|
| Rank | State | Obesity | Insufficient sleep | Anxiety disorders | Overall score /10 |
| 1 | Ohio | 36.4% | 39.9% | 19.1% | 8.00 |
| 2 | Louisiana | 39.9% | 40.5% | 18.6% | 7.68 |
| 3 | West Virginia | 41.2% | 42.6% | 18.3% | 7.48 |
| 4 | Alabama | 39.2% | 41.4% | 18.4% | 7.34 |
| 5 | Tennessee | 37.6% | 39.8% | 18.7% | 7.33 |
| 6 | Kentucky | -% | 39.6% | 18.9% | 7.14 |
| 7 | Alaska | 35.2% | 37.6% | 19.5% | 7.01 |
| 8 | Nevada | 30.8% | 39.3% | 19.6% | 6.77 |
| 9 | Delaware | 35.7% | 37.3% | 19.1% | 6.62 |
| 10 | Arkansas | 40.0% | 39.9% | 17.8% | 6.52 |
1. Ohio is the state most affected by poor health
Ohio ranks first with a combined health score of 8/10, showing some of the highest rates of obesity (36.4%) and sleep deprivation (39.9%) in the nation. Anxiety disorders affect nearly one in five adults (19.1%), highlighting how physical and mental health challenges can often coexist when left unmanaged.
Interestingly, data from IndustrySelect shows that Ohio is the third-biggest state for manufacturing. This raises important questions about the somewhat unavoidable impacts of industrial and shift-based work on overall well-being, as irregular hours can disrupt circadian rhythms, leading to sleep deprivation and weight gain.
2. Louisiana ranks second for combined health challenges
Louisiana ranks second with a combined health score of 7.68, driven by obesity and sleep deprivation levels well above national averages. Nearly four in ten adults (39.9%) live with obesity, compared with a U.S. average of 33.8%, while 40.5% report insufficient sleep (versus 35.3% nationally). Anxiety disorders affect 18.6% of adults, adding further pressure to overall well-being.
Socioeconomic factors likely contribute. Louisiana is the third-most poverty-stricken state in America, with 14.2% of families living below the poverty line – a situation that can heighten financial stress, limit access to nutritious food, and make healthy living harder to sustain.
3. West Virginia is the third least healthy state in the U.S.
With a combined score of 7.48 out of 10, West Virginia is in third place nationally for unhealthiness. The state has the highest obesity rate in the U.S. (41.2%), almost eight percentage points above the national average of 33.8%. It also reports that 42.6% of adults get insufficient sleep, compared with 35.3% nationwide, while 18.3% live with anxiety disorders.
Economic hardship and access to healthcare are key factors. West Virginia has the third-lowest median household income in the country and a large rural population, limiting access to nutritious food, recreation, and mental health services.
The US states with the highest rates of obesity
Obesity remains one of the most widespread health challenges in the United States, affecting 33.8% of adults nationwide. But the burden isn’t evenly distributed. The latest CDC data reveals clear regional divides, with rates exceeding 40% in several Southern and Midwestern states.
Seven of the ten most affected states also rank among those with the highest poverty levels, highlighting the close link between income, food access, and health outcomes. In parts of the Deep South, residents are more than 1.5 times as likely to live with obesity as those in the healthiest states, such as Colorado, where just 24.9% of adults are affected.
| Rank | State | Obesity prevalence in adults |
|---|---|---|
| 1 | West Virginia | 41.2% |
| 2 | Mississippi | 40.1% |
| 3 | Arkansas | 40.0% |
| 4 | Louisiana | 39.9% |
| 5 | Alabama | 39.2% |
| 6 | Oklahoma | 38.7% |
| 7 | Indiana | 37.8% |
| 7 | Iowa | 37.8% |
| 9 | Tennessee | 37.6% |
| 10 | Nebraska | 36.6% |
1. In West Virginia, 41.2% of adults are obese
West Virginia tops the list, with 41.2% of adults classified as obese – nearly double the rate in Colorado (24.9%) and close to eight percentage points higher than the national average (33.8%). The state’s economic and geographic landscape presents clear challenges: lower incomes, rural isolation, and reduced access to affordable, nutritious food make it harder for residents to maintain the healthy habits associated with weight management.
2. In Mississippi, 40.2% of adults are obese
Only slightly behind West Virginia is Mississippi, where around two in five (40.2%) of adults are classed as obese. When we explore the impacts of this, GlobalData research found that obesity rates reduced Mississippi’s economic activity by $4.3bn in 2023, highlighting how maintaining a healthy weight is important at the individual and state level.
3. In Arkansas, 40% of adults are obese
Arkansas ranks third, with 40% of adults living with obesity – the equivalent of nearly one million people statewide. The state borders Mississippi and Louisiana, reflecting a wider regional pattern across the Deep South where limited access to healthcare, lower incomes, and calorie-dense dietary traditions drive consistently high obesity rates.
Expert insights
A clear pattern emerges when comparing obesity rates with healthcare quality. Of the 10 most obese states in the U.S., six (West Virginia, Mississippi, Arkansas, Louisiana, Oklahoma, and Tennessee) also appear in the bottom 10 for healthcare quality, according to U.S. News & World Report.
This overlap points to a systemic issue: where healthcare infrastructure is weaker, preventive care and early weight-management support are less accessible.
In these regions, clinically supervised weight-loss medication, including prescription options such as compounded semaglutide, can provide a critical layer of support. Used alongside lifestyle changes, they offer a medically guided way to manage weight safely and effectively, helping to close the gap between health awareness and real-world outcomes.=
The US states with the highest rates of poor sleep
Sleep deprivation remains a widespread issue across the United States, with an average of 36.3% of adults reporting that they regularly fail to get enough rest. But new data shows the problem is far worse in some regions. In the most affected states, more than two in five adults experience insufficient sleep.
| Rank | State | Insufficient Sleep Prevalence in Adults |
|---|---|---|
| 1 | Hawaii | 45.9% |
| 2 | West Virginia | 42.6% |
| 3 | Alabama | 41.4% |
| 4 | Louisiana | 40.5% |
| 5 | Ohio | 39.9% |
| 5 | Arkansas | 39.9% |
| 7 | Tennessee | 39.8% |
| 8 | Kentucky | 39.6% |
| 9 | Nevada | 39.3% |
| 10 | Florida | 38.8% |
1. In Hawaii, 45.9% of adults get insufficient sleep
Hawaii is the only US state detached from mainland North America, and it appears to be the island that never sleeps, as almost 46% of adults don’t get as much sleep as they should.
Medical officials in Hawaii are aware of this as a state-level challenge, though, with public guidance stressing how chronic sleep deprivation can lead to an increased risk of potentially life-threatening health issues such as diabetes, obesity, cardiovascular diseases, and more.
This gap between official awareness and on-the-ground impact suggests that, for Hawaiians, more needs to be done to help adults get their recommended seven or more hours of sleep each night.
2. In West Virginia, 42.6% of adults get insufficient sleep
In second place, 42.6% of adults in West Virginia report not getting enough sleep – again, far above the U.S. average. The state also records the nation’s highest obesity rate, reinforcing the two-way link between poor sleep and weight gain.
Rural isolation, economic pressure, and above-average poverty in the state may also play a role, with limited healthcare access and elevated stress creating a broken sleep cycle that’s difficult to fix without targeted support.
3. In Alabama, 41.4% of adults get insufficient sleep:
Alabama completes the top three tiered states, as over 41% of all adults don’t get sufficient sleep at night. Alabama has one of the highest rates of diabetes in the country (13.7%), a condition which impacts sleep and can be caused by obesity.
The US states with the highest rates of anxiety disorders
While the other conditions analyzed in this report show significant regional variation, anxiety tells a different story. Across the U.S., anxiety disorder prevalence levels remain far more consistent, only ranging from 20.2% to 17.5%, showing anxiety to be a less widespread but more universal challenge to Americans.
| Rank | State | Anxiety Disorders Prevalence in Adults |
|---|---|---|
| 1 | California | 20.2% |
| 2 | Florida | 19.8% |
| 3 | Oregon | 19.7% |
| 4 | Nevada | 19.6% |
| 5 | Alaska | 19.5% |
| 6 | New York | 19.4% |
| 6 | Idaho | 19.4% |
| 6 | Massachusetts | 19.4% |
| 9 | Washington | 19.3% |
| 9 | Colorado | 19.3% |
1. With 20.2% of adults suffering from anxiety disorders, California is the most anxious state
California tops the list, with more than one in five adults (20.2%) reporting an anxiety disorder – the only state with a rate above 20%. The state’s high living costs, housing pressures, and demanding work culture could all be contributing factors, with financial stress consistently ranked among the leading triggers of anxiety nationwide.
2. In Florida, 19.8% of adults suffer from anxiety disorders
Despite its reputation for year-round sunshine, Florida records the second-highest anxiety rate in the US, at 19.8%. While sunlight can boost mood, experts suggest other regional factors, such as hurricane risk, population density, and healthcare access, may offset those benefits.
3. 19.7% of adults in Oregon suffer from anxiety disorders
Close in the rankings but at the other end of the country is Oregon, with 19.7% of adults experiencing anxiety disorders. The state has consistently reported high levels of mental health challenges, with factors such as long winters, high rates of substance use, and limited access to mental health services in rural areas contributing to the strain.
Expert insights
Research from health authorities globally shows a two-way relationship between obesity and mental health, as the stress hormone, cortisol, can increase appetite and cravings for fat or sugar-rich foods.
This is a cycle that can be difficult to break: poor mental health can drive unhealthy lifestyle habits, while obesity itself can heighten stress and body-image concerns, further fueling anxiety.
Tackling these conditions together with appropriate psychological and weight-loss treatments can offer a more sustainable route to long-term health improvement.
Standout health trends across the US
Clear regional patterns emerge when comparing rates of obesity, anxiety, and insufficient sleep across America.
- Southern and Midwestern states record the highest obesity rates. Nine of the ten most affected states fall within these regions, with economic disadvantage likely playing a role, as many parts of the South and Midwest have limited access to affordable, nutritious food and preventive healthcare.
- Southern and Appalachian states face the steepest combined health challenges. West Virginia, Louisiana, Alabama, and Tennessee all appear in the top ten for at least two indicators. These regions share systemic issues, such as limited healthcare access, food insecurity, and high poverty rates, that compound across both physical and mental health.
- Northern and Western states perform better overall. Colorado, Vermont, and Massachusetts have some of the lowest rates of obesity and sleep deprivation, reflecting stronger healthcare access and higher average incomes. Hawaii stands out as an anomaly: while it boasts the lowest obesity levels nationally, it also has the worst sleep deprivation rate (45.9%).
- Anxiety disorders are concentrated in high-density urban areas. Rates are highest along the coasts, with California, Florida, New York, and Massachusetts (four of the country’s most urbanized, high-pressure states) leading the way. Dense populations, long commutes, and high living costs appear to have a negative impact on individuals’ sense of well-being and stress levels.
Expert comment
Rob Stransky, President at NiceRx, explains how the three health concerns in the data – obesity, insufficient sleep, and anxiety – are more closely connected than most people realize, and shares insights on what can be done to address them.
“These issues rarely exist in isolation. Poor sleep can raise stress hormones, increasing the likelihood of weight gain, and carrying excess weight can disrupt sleep patterns and contribute to low mood or anxiety. Once this cycle begins, it can quickly reinforce itself.
The first step is recognizing the overlap and targeting small, sustainable changes across multiple areas rather than focusing on one symptom alone. For example:
- Sleep: Establish a consistent bedtime routine, limit caffeine and screen time before bed, and address potential medical causes, such as sleep apnea, through a professional assessment.
- Anxiety: Cognitive behavioral therapy (CBT), mindfulness techniques, and structured physical activity are all proven to lower anxiety levels. Even light exercise can improve both sleep quality and mood regulation, so aim to engage in some form of physical activity every day, if possible.
- Weight management: Combining a balanced diet with regular physical activity remains key. Where appropriate, clinically supervised treatments, including prescription options such as compounded semaglutide, can support individuals struggling to lose weight through lifestyle changes alone.
The goal isn’t perfection, it’s consistency. Tackling the behavioral, biological, and emotional factors together gives people the best chance of long-term improvement.”
Methodology
As a provider of weight loss medication, NiceRx is on a mission to help people feel great through better health, a large part of which includes tackling national health challenges such as obesity, anxiety, and sleep deprivation. This report on the prevalence of and correlation between these three conditions forms part of NiceRx’s commitment to supporting individuals in their efforts to lead healthier, happier lives by raising awareness about potential causes and solutions.
To create this report, each state was ranked on the prevalence in adults of the following factors:
- Obesity prevalence: www.cdc.gov/obesity/data-and-statistics/adult-obesity-prevalence-maps.html
- Sleep deprivation: www.cdc.gov/sleep/data-research/facts-stats/adults-sleep-facts-and-stats.html
- Anxiety disorders: https://huntingtonpsych.com/blog/anxiety-in-america-a-state-by-state-breakdown-of-anxiety-disorders
Each state was given a normalized score from 0 to 10 on these three factors, and an average score was taken for each. Note that obesity data were unavailable for Pennsylvania and Kentucky, so the scores for these states were calculated based on sleep deprivation and anxiety disorders.
We then calculated the correlation coefficient between the three variables to show the strength of the relationship between them.
All data was collected in October 2025 and is accurate as of that date.
