Obesity has increased rapidly during the last few decades and is a significant risk factor for many chronic diseases, often resulting in higher rates of morbidity and mortality. The role of eating behaviors and individual food choices, as well as the growing array of clinical tools to reduce obesity at the individual level, has received extensive attention as public health researchers seek to understand why the rate of obesity in the US has escalated so rapidly in a relatively short period. But the focus on individual actions and tailored clinical management can obscure how the larger environment shapes the available choices and opportunities, particularly for those in communities where obesity is common. A central feature of that environment is the quality of food access.

We explore how access to different types of retail food stores—which may in turn shape the foods that consumers choose—varies widely across the US, with particular attention to areas with higher rates of obesity. We find the following:

• While obesity is widespread in the US, it is not distributed equally across places. The highest obesity rates in the US are concentrated in Southern counties, particularly those in parts of Texas, Louisiana, Mississippi, Kentucky, and West Virginia. In contrast, the lowest obesity rates are concentrated in Western counties, especially those in Colorado and parts of Wyoming, California, and Nevada.
• On average, counties with high obesity rates have more food establishments per 1,000 residents than counties with low obesity rates.
• We find stark differences in the mix of food establishment types between low-, middle-, and high-obesity counties when we categorize food establishments by whether they are likely to serve healthy or unhealthy food. Among all food establishments, 65.5 percent are considered likely unhealthy in counties with a high percentage of residents with obesity compared with 51.5 percent in counties with a low percentage of residents with obesity. This pattern holds even after controlling for a variety of other county-level characteristics.
• Food establishments more likely to serve unhealthy foods are largely comprised of convenience stores, followed by gas stations, dollar stores, and pharmacies in both low- and high-obesity counties. However, dollar stores represent a substantially larger share of unhealthy food establishments in high-obesity areas than in low-obesity areas.

In this report, we use maps to explore the intersections of obesity and retail food stores, which can assist policymakers and communities in understanding how potential policies and interventions align with areas of higher risk. Some of the intersections we explore include race and ethnicity and the availability of Supplemental Nutritional Assistance Program (also known as SNAP) incentive plans.