The Fittest And Least Fit States In America, Ranked Across 10 Health Factors

Vermont leads the nation in fitness while Louisiana sits dead last, and the gap between them tells a stark story about how geography, lifestyle habits, and access to green space shape the health of an entire population.

A new analysis by Nursa, a per diem healthcare staffing platform, ranked all 50 states across 10 health and lifestyle metrics to produce what it calls the Fittest States Index. Vermont earned the top spot with a score of 8.97 out of 10, while Louisiana landed at the bottom with a 4.25. The two states couldn’t look more different on paper, and that difference matters well beyond bragging rights.

Poor fitness isn’t just a personal problem. Preventable diseases tied to sedentary behavior and bad diet strain healthcare systems nationwide. Understanding which states are winning that battle and which are losing offers a useful lens for thinking about what conditions help people actually stay healthy.

What Made Vermont America’s Fittest State?

Vermont’s top ranking was no accident. It excelled across nearly every category measured. Just 29.6% of Vermonters reported sleeping less than seven hours a night, the best rate in the country, compared to Hawaii, where nearly half the population (45.6%) falls short of that threshold. Sleep doesn’t always make the fitness conversation, but it plays a direct role in recovery, metabolism, and overall health.

Diet told a similarly impressive story. About 12.9% of Vermont adults reported eating two or more fruits and three or more vegetables daily. That’s 3.4 times the rate in Oklahoma, where only 3.8% of adults hit that same target, the worst rate in the nation. Only 16% of Vermont residents were classified as inactive outside of work, the second-lowest rate in the country. Mississippi was worst, at 30.6%.

Vermont also benefits from an abundance of gyms (13.1 per 100,000 residents), walking and hiking routes (31 per 100,000), and relatively few fast food locations: just 19.4 per 100,000 people, well below the national average of 24.1. Life expectancy sits at 78.4 years, and the adult smoking rate is 13.2%, below the national average of 16.3%.

Massachusetts came in second with a score of 8.73. Obesity there sits at 27%, seven percentage points below the national average of 34% and only 11.7% of residents smoke, the second-lowest rate in the country. Most notably, 68.1% of Massachusetts residents get at least 150 minutes of moderate aerobic activity per week, the highest rate of any state.

Washington ranked third (8.69), largely on the strength of its outdoor infrastructure. With 73.6 walking, running, and hiking routes per 100,000 residents, the most of any state, and a gym density of 15.3 per 100,000, Washington makes it relatively easy for residents to stay active. Just 17.4% of people there are inactive outside of work.

Colorado’s fourth-place finish (8.44) raised an eyebrow worth noting. It has the most fast food locations per 100,000 people in the nation (37.1) yet still boasts the lowest obesity rate in the country (25%) and the fewest inactive residents (15.6%). It also has the highest gym density of any state, at 16.5 per 100,000. Colorado appears to be an outlier where high fast food density hasn’t translated into poor health outcomes, possibly because of its strong culture of outdoor activity and access to exercise infrastructure.

Why the Least Fit States Keep Falling Behind

Louisiana scored 4.25 out of 10, the worst in the nation. It has the fewest gyms per 100,000 people at just 2.8, a 39.2% adult obesity rate, and a smoking rate of 21%: all among the worst in the country. Nearly 28% of residents are inactive outside of work, and only 42.8% get the recommended 150 minutes of weekly aerobic exercise.

Mississippi (4.36) and West Virginia (4.91) weren’t far behind. West Virginia holds the highest adult obesity rate in the nation, at 41.4%. More than 41% of its residents also sleep fewer than seven hours a night. Alabama (4.99) and Nevada (5.11) round out the bottom five. All five states in that group share limited gym access, high rates of physical inactivity, and elevated obesity and smoking figures.

It’s worth pointing out that Oklahoma, while ranking 8th worst overall (5.65), earned a specific distinction: its residents have the poorest diet of any state, with just 3.8% meeting basic daily fruit and vegetable guidelines.

The geography of unfit America skews heavily toward the South. Louisiana, Mississippi, West Virginia, Alabama, Tennessee, and Kentucky all land in the bottom ten. The concentration isn’t coincidental: these states also tend to have fewer parks and walking routes, lower gym density, and higher rates of food insecurity and smoking.

How the Fittest States Index Was Built

Nursa researchers pulled data from several credible sources. Obesity and smoking figures came from the Centers for Disease Control and Prevention. Sleep and inactivity data were sourced from America’s Health Rankings, as were diet figures: specifically the percentage of adults who eat at least two servings of fruit and three servings of vegetables per day, based on 2021 data. Exercise data came from the Apple Heart & Movement Study, which tracked the share of residents getting 150 or more minutes of moderate aerobic activity per week. Alcohol consumption figures came from World Population Review’s 2023 per capita data. Gym counts, walking and hiking route tallies, and fast food location density were all drawn from OpenStreetMap data across all 50 states.

Each state was scored on all 10 factors, and a percentrank method was used to calculate the final composite score out of 10. All data was finalized as of February 19, 2026.

The ranking doesn’t pretend to capture everything about a state’s health. Income, healthcare access, and food environment all play a role that a composite fitness score can’t fully account for. But as a snapshot of where Americans are moving, eating, sleeping, and smoking: it draws a clear enough picture.

Vermont’s top ranking reflects what happens when outdoor access, good sleep habits, low smoking rates, and active residents converge in the same place. Louisiana’s last-place finish reflects the opposite. Limited infrastructure for exercise, high rates of sedentary behavior, and some of the worst diet and smoking numbers in the country. The gap between them is wide, and it shows up in ways that go far beyond a single fitness score.

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Disclaimer: The Fittest States Index was commissioned and published by Nursa, a per diem healthcare staffing company, and has not been independently peer-reviewed. Rankings are based on a composite of publicly available health and lifestyle data and are intended for informational purposes only. This analysis should not be interpreted as medical advice or used as a substitute for guidance from a qualified healthcare professional.

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