CLARKSBURG, W.Va. (WBOY) — A recent study revealed that West Virginia is in the worst shape in the country, citing rates of certain health concerns that were 50% worse than the national average.

According to the study by Run Reviews, West Virginians have a heart disease rate of 7% compared to the national average of 4.3%, a diabetes rate of 15.7% compared to the national average of 10.8%, and an obesity rate of 39.1% compared to the national average of 32.1%. West Virginia’s rate of diabetes and heart disease are the highest in the country.

According to the study, Mississippi had the highest rate of obesity, which is the top indicator of being out of shape, but West Virginia came in at a close second.

On the other hand, West Virginia ranked second best in the country for annual wellness checkups, with 81.9% of residents going to the doctor each year.

With such a high elderly population, it is not surprising that West Virginians go to the doctor more and have a higher rate of certain illnesses. According to the U.S. Census Bureau, West Virginia’s who are 65 or older make up 20.9% of the population. In the states that were deemed the most in shape—Washington D.C., Massachusetts and Colorado—the percentage of people over 65 was much less. Washington D.C.’s elderly population was estimated at 12.8% in 2021, which is 48% less than West Virginia.

The study also determined that West Virginians have limited access to gyms, only 7.5 for every 100,000 people, which dropped the state score. However, West Virginians also have access to outdoor physical activities that don’t require gyms or facilities, so that score does not accurately represent West Virginians’ access to opportunities to be active.