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On Monday, WalletHub released its ranking of the top cities nationwide that are struggling with weight-related health issues like obesity.

The study looks at the top 100 most populated cities in the U.S., examining factors like the number of physically inactive adults, healthy food access and projected obesity rates by 2030.

According to WalletHub, the country’s obesity epidemic costs over $190 billion in medical treatments per year and has caused around $4.3 million worth of productivity loss in the workplace.

“Americans are some of the most overweight people in the world, not just stereotypically but statistically, too,” the report reads. “In fact, nearly 42% of U.S. adults are obese, and it’s costing us.”

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Of the Florida cities on the list — Jacksonville, Orlando, Miami and Tampa — Orlando ranked the highest at No. 71.

However, Florida in general fell rather low on the list, with cities like McAllen, Texas and Jackson, Mississippi taking the top two spots for “fattest cities.”

Of the states that were on the list, Mississippi and Louisiana had the top two average scores, respectively. Meanwhile, Florida ranked toward the bottom of the list at No. 31.

The full list of cities is as follows:

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