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Tennessee moved from the middle of the pack in 1997 to the second spot by 2008 in state rankings for the percentage of overweight people. Although the reasons for the fat splurge are hard to pinpoint, people on the front lines of the fight against obesity often cite a lack of good information about healthy eating and active living.

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There’s evidence that public campaigns to change behavior are getting results, but there’s also concern that the message may not be taking hold in rural areas. Tennessee dropped two spots to being the fourth-most-overweight state, based on data from the U.S. Centers for Disease Control and Prevention. Schlundt took the raw data and analyzed them for trends.

Places such as Lawrenceburg don’t have YMCAs that offer discounted rates or free access. Nor have they received millions of dollars in federal funds to combat obesity such as the $7.5 million grant Nashville’s Metro Public Health department received.

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Besides tracking the percentage of people overweight, the CDC also keeps tabs on those who are fat enough to be considered obese. Tennessee dropped from third in this category in 2009 to eighth in 2010. But only a fraction of a percentage point separated it from Texas, Louisiana, Kentucky and South Carolina, which did worse.