Nebraska was named the 18th most obese state in America, according to a recent national ranking from two health organizations.

The fifth annual “F as in Fat: How Obesity Policies Are Failing in America, 2008” report was released last week from the Trust for America’s Health and the Robert Wood Johnson Foundation.

Nebraska’s adult obesity rate is 26.5 percent. That rate has increased three years in a row.

Nationally, adult obesity rates rose in 37 states in the past year. Rates rose for a second consecutive year in 24 states and for a third straight year in 19 states. No state saw a decrease.

In 28 states, more than a quarter of adults are obese, which is an increase from 19 states last year. In every state except Colorado, more than 20 percent of adults are obese. In 1991, no state had an obesity rate above 20 percent. Now, an estimated two-thirds of American adults are overweight or obese.

Mississippi has the highest rate of obesity, with 31.7 percent of adults considered obese. Colorado has the lowest rate (18.4 percent of adults are obese).

Rates of type 2 diabetes, a disease typically associated with obesity, increased in 26 states last year, including in Nebraska. Nebraska ranks 32nd highest in type 2 diabetes, with 7.3 percent of the population affected, and it ranks 37th highest for hypertension.

The “F as in Fat” analyzes information from the annual Behavioral Risk Factor Surveillance Survey by the federal Centers for Disease Control and Prevention. Rankings are based on three years of data (2005-07) that are averaged for each state’s obesity rate.

The report also reviews state and federal policies aimed at reducing or preventing obesity in children and adults. It shows that many policies are missing critical components or require a more comprehensive approach to be truly effective. Among the examples highlighted:

- While all 50 states and the District of Columbia have passed laws related to physical education and/or physical activity in schools, only 13 states include enforceability language. Nebraska does not have enforceability language. Of these states, only four — Arkansas, Florida, New Mexico, and Oklahoma — have sanctions or penalties if the laws are not implemented.

- While the Dietary Guidelines for Americans were updated in 2005, the U.S. Department of Agriculture school meal program has yet to adopt the recommendation.

- Eighteen states have enacted legislation requiring school meals to exceed USDA nutrition standards. Nebraska has not enacted this type of legislation.

- Ten states do not include specific coverage for nutrition assessment and counseling for obese or overweight children in their Medicaid programs. Nebraska includes this type of specific coverage.

- Twenty states explicitly do not cover nutritional assessment and consultation for obese adults under Medicaid. Nebraska does not provide this coverage.

- Only two states — Georgia and Vermont — have specific guidelines for treating obese adults in their Medicaid programs. In Nebraska and South Carolina, the Medicaid programs specifically state that obesity is not an illness and is therefore not covered.

The “F as in Fat” report concludes with a recommendation that the country set a national goal of reversing the childhood obesity epidemic by 2015. To help achieve that goal, the report’s top recommendation calls on the federal government to convene partners from state and local governments, businesses, communities, and schools to create and implement a realistic, comprehensive National Strategy to Combat Obesity. Some key policy recommendations include:

- Investing in community-based disease-prevention programs that promote increased physical activity and good nutrition;

- Improving the nutritional quality of foods available in schools and childcare programs;

- Increasing the amount and quality of physical education and activity in schools and childcare programs;

- Increasing access to safe, accessible places for physical activity in communities. Examples include creating and maintaining parks, sidewalks and bike lanes and providing incentives for smart growth designs that make communities more livable and walkable;

- Improving access to affordable nutritious foods by providing incentives for grocery stores and farmers’ markets to locate in underserved communities;

- Encouraging limits on screen time for children through school-based curricula and media literacy resources;

- Eliminating the marketing of junk food to kids;

- Encouraging employers to provide workplace wellness programs;

- Requiring public and private insurers to provide preventive services, including nutrition counseling for children and adults; and

- Providing people with the information they need about nutrition and activity to make educated decisions, including point-of-purchase information about the nutrition and calorie content of foods.