by Charles B. Stockdale, Douglas A. McIntyre and Michael B. Saute

10. New Mexico

Grocery Stores Per 1,000 Residents: 0.26 (23rd)
Amount Spent on Fast Food Per Capita: $737 (8th most)
Gallons of Soft Drinks Purchased Per Capita: 58 (12th least)
Pounds of Sweet Snacks Purchased Per Capita: 111 (13th least)

New Mexico's worst rankings occur in two metrics. It has the 44th-greatest percentage of households without a car that are more than 10 miles from a supermarket or grocery store and the 44th-greatest percentage of population that has low income and is more than 10 miles from a supermarket or grocery store, according to the United States Department of Ag1riculture. These metrics are significant because they suggest a lack of access to affordable and nutritious food. Residents may rely on fast food restaurants and convenience stores instead. New Mexico has the eighth-greatest amount of money spent on fast food per capita among all the states considered.

9. Arizona

Grocery Stores Per 1,000 Residents: 0.17 (47th)
Amount Spent on Fast Food Per Capita: $761 (4th most)
Gallons of Soft Drinks Purchased Per Capita: 60 (21st least)
Pounds of Sweet Snacks Purchased Per Capita: 109 (11th least)

Arizona has the second-fewest grocery stores per person, with only 0.17 for every 1,000 people. This illustrates a major restriction on healthy food access for one of the country's fastest growing states. One of the ways in which residents of Arizona are supplementing their diets is with fast food. Arizonans spent an average of $760.50 each on fast food in 2007, the fourth-greatest amount among the states.

8. Ohio

Grocery Stores Per 1,000 Residents: 0.18 (45th)
Amount Spent on Fast Food Per Capita: $622 (20th least)
Gallons of Soft Drinks Purchased Per Capita: 70 (11th most)
Pounds of Sweet Snacks Purchased Per Capita: 122 (10th most)

Because a large part of Ohio's poor population is located in major urban centers like Cleveland and Cincinnati, the state ranks well in regards to access to grocery stores among the poor. However, the state ranks third-worst in store availability across all income classes at 0.18 locations per 1,000 people, compared to 0.6 in first place North Dakota. Ohio's population has the 11th-greatest consumption of soft drinks, and top-10 highest consumption of both sweet snacks and solid fats. As a result of these poor diets, Ohio has an adult diabetes occurrence of over 10%, which is the 11th-worst rate in the country.

7. South Dakota

Grocery Stores Per 1,000 Residents: 0.5 (4th)
Amount Spent on Fast Food Per Capita: $547 (9th least)
Gallons of Soft Drinks Purchased Per Capita: 64 (23rd least)
Pounds of Sweet Snacks Purchased Per Capita: 122 (8th most)

South Dakota has the fifth-smallest population in the country, and yet, it is the 17th-largest state in terms of geographic area. As a result, many residents have limited access to affordable and nutritious food. In fact, South Dakota has the greatest percentage of households with no car and which are more than 10 miles from a supermarket or grocery store, as well as the greatest percentage of low-income households which are more than 10 miles from a supermarket or grocery store. Only 10.1% of adults in South Dakota consume the U.S. Department of Health and Human Services' recommended two or more fruits and three or more vegetables per day, compared to the national average of 14%. This is the fifth-worst rate in the nation.

6. Nevada

Grocery Stores Per 1,000 Residents: 0.23 (29th)
Amount Spent on Fast Food Per Capita: $939 (most)
Gallons of Soft Drinks Purchased Per Capita: 58 (10th least)
Pounds of Sweet Snacks Purchased Per Capita: 114 (19th least)

Nevada spends the most per capita on fast food -- nearly $940 per person per year. This is roughly 25% more than Texas, the second-worst state, and well more than twice what Vermont residents spend. As might be expected, the state ranks in the bottom 10 for both households with no cars and low-income populations, defined as people with income less than 200 percent of the federal poverty thresholds, and proximity to grocery stores. Nevada's obesity and diabetes rates, are above average.

5. Oklahoma

Grocery Stores Per 1,000 Residents: 0.25 (24th)
Amount Spent on Fast Food Per Capita: $676 (15th most)
Gallons of Soft Drinks Purchased Per Capita: 69.8 (8th most)
Pounds of Sweet Snacks Purchased Per Capita: 103.2 (3rd least)

The rate of household-level food insecurity, including households with food access problems as well as households that experience disruptions in their food intake patterns due to inadequate resources for food, is 15.2% in Oklahoma. The national rate is 13.5%. Oklahoma also has the third-lowest rate of adults who meet the recommended two fruit/three vegetable daily intake, with only 9.3% of adults doing so. Perhaps this is part of the reason Oklahoma's obesity rate is 31.4%, the fifth-worst in the country.

4. Kansas

Grocery Stores Per 1,000 Residents: 0.35 (7th)
Amount Spent on Fast Food Per Capita: $610 (19th least)
Gallons of Soft Drinks Purchased Per Capita: 64 (23rd most)
Pounds of Sweet Snacks Purchased Per Capita: 121 (12th most)

Kansas has some of the easiest access (seventh-best) to stores where cheap and healthy food is available. It is clear, however, that most residents do not take advantage of this, as the state has one of the worst diets in the country. Residents consume the 12th-most sweet snacks per person as well as the 12th-most solid fats -- more than 20 pounds per person. The state ranks 28th in adult diabetes and 31st in obesity -- 28% of the state's adults are considered overweight.

3. Missouri

Grocery Stores Per 1,000 Residents: 0.26 (22nd)
Amount Spent on Fast Food Per Capita: $623 (21st least)
Gallons of Soft Drinks Purchased Per Capita: 65 (18th highest)
Pounds of Sweet Snacks Purchased Per Capita: 121 (17th most)

Missouri does not rank especially poor in any of the metrics considered, however it does rank badly in about almost every one. It has the 11th-lowest rates of adults eating the recommended amount of fruits and vegetables, the eighth-greatest rate of food insecurity, and relatively high rates of soft drink, sweet snack and solid fats consumption. Missouri has the ninth-worst rate of obesity among adults, with 30% having a body mass index greater than 30.

2. Alabama

Grocery Stores Per 1,000 Residents: 0.21 (37th)
Amount Spent on Fast Food Per Capita: $649 (23rd most)
Gallons of Soft Drinks Purchased Per Capita: 77 (4th most)
Pounds of Sweet Snacks Purchased Per Capita: 113 (16th least)

Alabama residents consume 77 gallons of soft drinks per capita per year, the fourth-highest amount in the country. This is roughly 33% more than Oregon, which consumes the least. Soft drinks like cola have more sugar per ounce than nearly any other food we regularly consume, and it is clear that soda has helped contribute to Alabama's poor health outcomes. The state has the seventh-highest obesity rate and, predictably, the second-worst diabetes rate. More than 12% of the state's adult population has the disease.

1. Mississippi

Grocery Stores Per 1,000 Residents: 0.21 (34th)
Amount Spent on Fast Food Per Capita: $588 (17th least)
Gallons of Soft Drinks Purchased Per Capita: 82 (most)
Pounds of Sweet Snacks Purchased Per Capita: 113 (17th least)

Mississippi has the worst eating habits in the country. Only 8.8% of the adult population eats the recommended amount of daily fruits and vegetables, the lowest rate in the country. Residents consumed just under 82 gallons of soft drinks per capita in 2006, the greatest amount reported. Furthermore, the state has the third-highest rate of household-level food insecurity, with 17.1% of households being affected. It is perhaps unsurprising, then, that the state has the highest rates of both adult diabetes (12.8%) and adult obesity (34.4%).

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