Vermont is the healthiest U.S. state, while Louisiana is the least healthy, according to the 19th annual America’s Health Rankings report, issued by the United Health Foundation, the American Public Health Association, and the Partnership for Prevention advocacy group. The rankings are based on 22 health measures, including factors that affect a population’s future health and ones that measure health outcomes that have already occurred. It was the second year in a row that Vermont earned the healthiest distinction. The next healthiest states were Hawaii (second place), New Hampshire (third), Minnesota (fourth), and Utah (fifth). Mississippi, which ranked as the unhealthiest state last year, came in 49th this year; above Mississippi were South Carolina (48th), Tennessee (47th), and Texas (46th).

The report also says that attempts to improve the health of Americans are not making notable progress. About 1 in 4 Americans is considered obese, putting them at risk for such health problems as heart disease, stroke, high blood pressure, diabetes, and certain types of cancer.

Notice that the bottom 15 unhealthiest states, with the exception of Nevada & Missouri, are so-called southern bible-belt states. Just a coincidence? Virginia ranks 30th overall.