A total of 16 states had obesity rates of 35% or more in 2020, up from nine states in 2018. Just two decades ago, no state had an adult obesity rate above 25%.

Experts say the CDC figures, based on self-reported data of height and weight, represent an alarming trend because obesity is linked to type 2 diabetes, heart disease, stroke and many types of cancer. It also increases health spending by $149 billion a year and raises the risk of COVID-19 hospitalization and death, according to the Trust for America’s Health, which released a report analyzing the CDC figures.

Obesity increased during the coronavirus pandemic as stressed Americans lost jobs, changed eating habits, reduced physical activity and had higher rates of food insecurity, said Nadine Gracia, CEO of Trust for America’s Health.

“The pandemic has placed many people and communities at greater risk of changing eating habits because of those social and economic disruptions,” she said.