West Virginia is the most obese state in the nation, according to the latest rankings from U.S. News & World Report.

Nearly 42% of adults who live in West Virginia are considered obese, based on self-reported survey data from the Behavioral Risk Factor Surveillance System, which is a partnership between the Centers for Disease Control and Prevention and state health departments.

Arkansas (40.5%), Mississippi (40.4%), Louisiana (39.9%) and Alabama (39.4%) round out the top five most obese states, according to the data.

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Obesity is defined by the CDC as having a body mass index of 30 or above — although using the body mass index as a health calculator has limitations since it does not distinguish between muscle and fat and was designed without a variety of factors, including gender.

U.S. News & World Report said around 2 in 5 American adults are obese, which can lead to medical issues ranging from stroke and diabetes to heart attack and cancer.

It’s also estimated to cost the country’s health care system nearly $173 billion a year, U.S. News & World Report stated.

As for the least obese states? They are Colorado (24.6%), Hawaii (26.8%), Massachusetts (27.1%), California (27.7%) and New York (27.9%).