WASHINGTON — Adult obesity rates increased in 23 states in 2008, down from 37 states during the previous year, according to "F as in Fat: How Obesity Policies are Failing in America 2009."

"Our health care costs have grown along with our waist lines," said Jeff Levi, executive director of the Trust for America’s Health, the organization that produced the report, which is now in its sixth year of publication. "The obesity epidemic is a big contributor to the skyrocketing health care costs in the United States. How are we going to compete with the rest of the world if our economy and workforce are weighed down by bad health?"

The report, which covered all 50 states and the District of Columbia, found 16 states experienced an increase in obesity rates for the second year in a row and 11 states for a third year in a row. No states decreased.

The rate of adult obesity now exceeds 25% in 31 states, which is an increase from 28 states last year. In addition, the rate of obesity exceeds 20% in 49 states. As recently as 1991, no states had obesity rates of more than 20%. In 1980, the national average of obese adults was 15%.

For adult obesity rates, Mississippi once again fared the worse as it came in at 32.5%, the fifth consecutive year it has topped the list. Other states topping the 30% rate were Alabama (31.2%), West Virginia (31.1%) and Tennessee (30.2%).

Colorado once again was the best coming in at 18.9%. Eight of the 10 states with the highest obesity rates were in the South, while northwestern and western states continued to have the lowest obesity rates.

Mississippi also was the worst in terms of overweight children ages 10 to 17, with a rate of 44.4%. The next closest states were Arkansas, at 37.5%, and Georgia, at 37.3%. The two states with the lowest childhood obesity rates were Minnesota and Utah at 23.1%.

The report also included a review of federal and state government policies aimed at reducing or preventing obesity. The review found that:

• Nineteen states have nutritional standards for school lunches, breakfasts and snacks that are stricter than current U.S. Department of Agriculture requirements. By comparison, five years ago only four states had such legislation.

• Twenty-seven states have nutritional standards for competitive foods sold a la carte, in vending machines, in school stores or in school bake sales. Five years ago, only six states had such nutritional standards.

• Twenty states have passed requirements for body mass index (B.M.I.) screenings of children and adolescents or have passed legislation requiring other forms of weight-related assessments in schools. Five years ago, only four states had passed screening requirements.

"Reversing the childhood obesity epidemic is a critical ingredient for delivering a healthier population and making health reform work," said Risa Lavizzo-Mourey, president and chief executive officer of the Robert Wood Johnson Foundation. "If we can prevent the current generation of young people from developing the serious and costly chronic conditions related to obesity, we can not only improve health and quality of life, but we can also save billions of dollars and make our health care systems more efficient and sustainable."

The report also identified several recommendations to make preventing and reducing obesity a central objective of health reform, and called for a "National Strategy to Combat Obesity."

"The National Strategy to Combat Obesity would define roles and responsibilities for federal, state and local governments and promote collaboration among businesses, communities, schools and families," the report noted.

For the full report, visit healthyamericans.org/reports/obesity2009.