Hawaii adults continue to be among the most physically active and leanest in the nation, according to a national report released today.

Isle adults have the fifth lowest obesity rate at 21.8 percent (up from last year's 20.7 percent) and the 48th lowest rate of physical inactivity at 19 percent.

But Hawaii youths, ages 10 to 17, had a higher rate of obesity, 28.5 percent, for a ranking of 37th in the nation.

Obesity rates and trends from 2006 to 2008 are presented in “;F as in Fat: How Obesity Policies are Failing in America 2009”; by the Trust for America's Health and the Robert Wood Johnson Foundation.

“;More than two-thirds (67 percent) of American adults are either overweight or obese,”; the annual report says, citing poor nutrition and physical inactivity as major culprits.

The report calls the high obesity rate an epidemic and that has spurred an increase in type 2 diabetes and other costly chronic diseases, “;harming the health of millions of Americans and resulting in billions of additional dollars in health care costs.”;

Adult obesity rates increased in 23 states and are above 30 percent in four states—Mississippi, West Virginia, Alabama and Tennessee. No state had a decrease, the report said. In 1991 no state had an obesity rate above 20 percent.

The percentage of obese and overweight American children is at or above 30 percent in 30 states.

“;Our health care costs have grown along with our waist lines,”; Jeff Levi, executive director of Trust for America's Health, said in a news release.

The data showed a relationship between poverty and obesity. Seven states with the highest poverty rates are among the top 10 states with highest obesity rates.

Hawaii tied Vermont for 48th in the nation with the third lowest poverty rates for the three-year period.

Mississippi had the highest rate of obese and overweight children at 44.4 percent. Eight of the 10 most obese states are in the south and all 10 states with the highest diabetes and hypertension rates are in the south, the report said.

Colorado is the only state with an adult obesity rate below 20 percent—at 18.9 percent.

Childhood obesity rates have tripled since 1980, the report said, stressing the urgency of reversing the trend for “;a healthier population and to make health reform work.”;

Hawaii is among states with no nutritional standards for school lunches, breakfasts and snacks stricter than federal requirements; with no nutritional standards for competitive foods sold in vending machines; and without body mass index screening programs for children and adults.

The obesity epidemic is likely to worsen with the economic crisis as Americans become uninsured or underinsured and can't afford healthier foods that are generally higher in cost, the report said.

“;As more Americans face trying to manage health issues with fewer resources, it is time to redouble national efforts to address the obesity epidemic,”; it said.

Combating obesity should be a top priority of the president, and the federal government should take the lead to create a strategic approach to address the problems, the study recommends.