South Carolina has, once again, landed near the top of a new list of fattest states.

The Big 10

The states with the highest obesity rates:

1. Louisiana (34.7 percent)

2. Mississippi (34.6 percent)

3. Arkansas (34.5 percent)

4. West Virginia (33.8 percent)

5. Alabama (33 percent)

6. Oklahoma (32.2 percent)

7. South Carolina (31.6 percent)

8. Indiana (31.4 percent)

9. Kentucky (31.3 percent)

10. (tie) Tennessee and Michigan (31.1 percent)

Source: “F as in Fat: How Obesity Threatens America's Future 2013”

But here's a silver lining: Other Southern states have shown ways to improve childhood obesity in just a few years.

What is BMI?

Body Mass Index, which is a function of height and weight, is used to determine obesity.

An adult with a BMI of 30 or higher is considered obese, while an adult with a BMI between 25 and 29.9 is overweight. A 5-foot-3 adult who weighs 141 pounds is overweight; an adult of the same height who weighs 170 pounds is obese.

Calculate your own BMI using a calculator on the National Institutes of Health website,

“The signs of progress that we're seeing around the country are very, very encouraging,” said Dwayne Proctor, director of childhood obesity programs at the Robert Wood Johnson Foundation.

Proctor cited statewide programs in Arkansas — healthier school lunches, better access to outdoor space — that have improved childhood obesity rates there in less than three years.

He said the Centers for Disease Control and Prevention also published data this month that show childhood obesity rates are slightly down in Georgia, Florida and Mississippi, too. In total, childhood obesity has decreased in 18 states in different pockets of the country.

“When it comes to adults, it could take longer because children ... attend schools, so it's easier to get to them,” Proctor said. Data from South Carolina was not included in the CDC report.

In a separate report, the Robert Wood Johnson Foundation and the Trust for America's Health published the annual “F as in Fat” rankings last week, showing that a larger percentage of South Carolina adults were obese in 2012 than in 2011. It forced the state up one spot up in the national rankings. South Carolina is now the seventh most obese state in the U.S. Last year, it tied for eighth with Indiana.

The report shows that 31.6 percent of adults in South Carolina are obese. That's up from 30.8 percent in 2012. “When you have a slight increase or decrease in a percentage point, it is a pretty big deal,” Proctor said.

These rates do not include the percentage of adults who are simply overweight, a lower threshold than obesity. The percentage of adults in South Carolina who are either overweight or obese is 66.2 percent.

“It's an incredibly challenging thing to deal with,” said Edward Archer, a researcher at the University of South Carolina's Arnold School of Public Health.

Archer recently wrote a report about how the sedentary habits of pregnant women, including many African-Americans in poorer, rural parts of the state, are making South Carolina's children obese.

“We need to get pregnant women active during the pregnancy,” Archer said. “We need to then keep these children from sitting in front of the television.”

Access to outdoor space and sidewalks, the prevalence of technology in the home and physical activity in schools are also playing a part in the obesity epidemic in South Carolina, he said.

Tony Keck, director of the S.C. Department of Health and Human Services, called obesity a fast-growing, complex problem that must be solved through collaboration.

“That means that health care does have a role. Schools have a role. Public safety has a role, in terms of making sure streets are safe and playgrounds are safe. Local, state and federal transportation departments have a role in making sure people have opportunities to walk or bike,” he said. “All of these things contribute to the growing problem of obesity and it's not just rich and poor. It's not just black and white. It's everybody, so you have to get everybody around the table.”

Keck and other state leaders are pursuing various proposals, such as reimbursing dietitians to counsel obese Medicaid patients and limiting what food stamp recipients can buy with their EBT cards. Both require the federal government's approval.

Other efforts to address obesity in the state include an obesity task force organized by the S.C. Medical Society. Another collaboration of several private and public organizations, including the S.C. Hospital Association and the S.C. Chamber of Commerce, is also tackling the issue.

“That type of layered approach where a broad swath of the community understands that it takes everybody to contribute to the public's health, including the public themselves, that's the only way that you actually make progress on these things,” Keck said.

Locally, a new program by Eat Smart Move More Charleston Tri-County called “Let's Go!” is designed to improve eating habits and increase physical activity in the greater Charleston area.

“We're seeing pockets of change,” said Mike Campbell, chairman of the local group. “Community change — we don't have that yet.”

Campbell said the group is working with local governments and other agencies, including the Medical University of South Carolina. They will use data published by the state health department to measure local progress, he said.

According to the “F as in Fat” report, there's much progress to be made. South Carolina ranks seventh in the country for adults with diabetes (11.6 percent) and seventh for adults with hypertension (36.4 percent).

Louisiana topped the annual list with 34.7 percent of its population classified obese. Colorado had the lowest obesity rate in the country — less than 21 percent.

Reach Lauren Sausser at 937-5598.