Being overweight or obese isn't just bad for your health, it's likely to cost you a fortune. Obese adults spend 42% more on direct healthcare costs than adults who are a healthy weight, according to The State of Obesity, an annual report on obesity in America.

Forty percent of Americans over age 15 are obese, and this epidemic continues to worsen, according to the Organisation for Economic Co-operation and Development.

Is location a factor? It seems so. There are things a community can do to reduce obesity, according to the OECD's report, such as ensuring the availability of healthy food retailers in underserved communities, meeting or exceeding federal nutrition standards for school meals, and increasing access to parks and recreational activities.

To find the fattest U.S. cities, personal finance site WalletHub compared 100 of the most populated U.S. metro areas across 19 key indicators of weight-related problems, ranking them in these three categories:

The obesity and overweight category is based on the share of overweight and obese adults, teens and children, as well as the area's projected obesity rates. (The CDC defines overweight as having a body mass index of 25 to 29. A BMI of 30 or higher is considered obese.)

The health consequences category considers the share of adults in the city with high cholesterol, diabetes, high blood pressure and heart disease, as well as the obesity-related death rate. These are all health problems typically related to obesity.

Lastly, in the food and fitness category, each city is scored based on factors that include the share of adults with low fruit and vegetable consumption, access to healthy food, share of physically inactive adults, the city's friendliness toward an active lifestyle, and access to parks and recreation.

Based on WalletHub's study, these are the fattest cities in America in 2019:

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