Mississippi has kept its U.S. heavyweight title for a fifth straight year, with the state’s population topping the latest survey of U.S. obesity rates among both adults and children.

While the percentage of adults classified as obese went up in 23 states, Mississippi stayed atop the latest annual rankings by the Robert Wood Johnson Foundation and the Trust for America’s Health with 32.5 percent. The same survey put the state’s adult obesity rate at 31.7 percent in 2008.

In addition, 44.4 percent of Mississippi children ages 10 to 17 are classified as overweight or obese, the study found.

Doctors have linked obesity to increased risks of a variety of conditions, including diabetes, hypertension, arthritis and heart disease. Wednesday’s study found that the current U.S. economic slump could worsen the problem by putting more nutritious food out of the reach of struggling families.

“At the same time, safety-net programs and services are becoming increasingly overextended as the numbers of unemployed, uninsured and underinsured Americans continue to grow,” the report states. “For many people, too, worries over the recession are triggering increased depression, anxiety and stress, which often can be linked to obesity.”

Rounding out the top five states among adults were West Virginia, with 31.2 percent of its population considered obese; Alabama, 31.1 percent; Tennessee, 30.2 percent; and South Carolina at 29.7.

At the bottom of the rankings, Colorado had the lowest percentage of obese adults, with 18.9 percent. It was followed by Massachusetts, at 21.2 percent; Connecticut, 21.3; Rhode Island, 21.7; and Hawaii, 21.8. Even in those states, the obesity rate grew by fractions of a percent since 2008, according to the study.

The survey used the Body Mass Index standards set by the U.S. Centers for Disease Control and Prevention. The CDC defines someone as obese if they have a BMI — a figure based on a ratio of height to weight — of 30 or more, while anyone with a BMI between 25 and 30 is considered overweight.

Adult obesity rates went up in 23 states in the past year, with 31 states now reporting rates over 25 percent. By comparison, no state topped 20 percent in 1991, the survey’s authors reported.