New data ranking state-by-state obesity rates is out today, and despite some modest improvements, the statistics are still pretty grim.

According to the report conducted by the Trust for America’s Health and the Robert Wood Johnson Foundation, adult obesity rates now exceed 35 percent in four states and 30 percent in 25 states. What’s more, obesity rates are above 20 percent in every single state across the country.

To put that in perspective, the authors point out that in 1991, no state had a rate above 20 percent.

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Colorado had the lowest obesity rate in 2015 at 20.2 percent.

And the state with the highest adult obesity rate in 2015? That would be Louisiana at 36.2 percent. Mississippi, Alabama and West Virginia weren’t far behind, all with obesity rates above 35 percent.

Trust for America’s Health

The analyses are based on data from the U.S. Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS).

Dr. Donald F. Schwarz of the Robert Wood Johnson Foundation called the report an “urgent call to action.”

“The stakes could not be higher,” he said in a press briefing this morning.

The report, entitled “The State of Obesity: Better Policies for a Healthier America,” also found that obesity rates decreased in four states – Minnesota, Montana, New York and Ohio. Only two states – Kansas and Kentucky – saw their obesity rates get worse. In all other states, the obesity rates remained stable from 2014 to 2015.

This marks the first year in the past decade that any states have experienced decreases, with the exception of a decline in Washington, D.C. in 2010.

Yet, despite small signs of progress, “obesity remains one of the biggest and costliest health threats in the country,” said Richard Hamburg, interim president and CEO, Trust for America’s Health.

The condition continued to put millions of Americans at increased risk for a range of chronic diseases, such as diabetes and heart disease, and costs the country between $147 billion and $210 billion each year, the authors note.

After Louisiana, the states with the highest obesity rates include Mississippi, West Virginia, Alabama, and Kentucky.

The report showed nine of the 11 states with the highest obesity rates are in the South and 22 of the 25 states with the highest rates of obesity are in the South and Midwest.

The results also shed some light on racial and ethnic disparities. Specifically, the report found:

Adult obesity rates are at or above 40 percent for blacks in 14 states.

Adult obesity rates are at or above 30 percent for blacks in 40 states and Washington, D.C.

Adult obesity rates are at or above 30 percent for Latinos in 29 states and Washington, D.C.

Adult obesity rates are at or above 30 percent for whites in 16 states and Washington, D.C.

American Indian/Alaska Natives have an adult obesity rate of 42.3 percent.

Studying such inequities is important, researchers say, as they allow state, local, and federal officials to recognize patterns and implement research-based strategies to help fight obesity.

“This year’s State of Obesity report is an urgent call to action for government, industry, healthcare, schools, child care and families around the country to join in the effort to provide a brighter, healthier future for our children. It focuses on important lessons and signs of progress, but those efforts must be significantly scaled to see a bigger turn around,” Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, said in a statement. “Together, we can build an inclusive Culture of Health and ensure that all children and families live healthy lives.”

The authors outline a set of policy recommendations to accelerate progress in addressing obesity. These include investing in obesity prevention; focusing on early-childhood and school-based programs centered around healthier meals, physical activity, and limiting screen time; prioritizing active transportation planning and access to healthy quality foods at the community level; and covering the full range of obesity prevention, treatment and management services under all public and private health plans.

“It’s much easier to prevent obesity and unhealthy weight gain than it is to try to reverse it later,” Schwarz said.