South Dakota is on the list because of its high school obesity rate,  which is the 12th highest in the U.S. at 14.7 percent. The adult obesity rate is 23rd, currently at 29.8 percent, up from 18.4 percent in 2000 and from 10.7 percent in 1990. It has been slowly decreasing while the number of obese adolescents has spiked since 2013.