The lighter side of real estate

The 10 Most Unhealthy Cities in America

From poor air quality to a lack of healthy food, we've determined the big cities cities where you're least likely to get and stay healthy.

Randy Nelson

Content Manager

119 articles, 53 comments

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Your city is trying to kill you—or at least it isn’t helping keep you alive. While there’s always plenty of talk about how crime and violence make particular cities dangerous to live in, we don’t always consider the things that are slowly (or sometimes not-so-slowly) conspiring to send us to an early grave. Things like the quality of the air we breath or how easily we can get healthy food (or, conversely, food that is absolutely horrible for us).

We’ve been looking at some fun city-related topics here recently on the Movoto blog, but this time around we decided to get a little more serious. Where, we wondered, are the unhealthiest cities; the places where the deck is stacked against residents getting or staying healthy, and where there are some clear signs of the difficulty in doing so.

So we did the research and found just that: America’s 10 most unhealthy cities. These are places where the residents aren’t just unhealthy—the cities themselves are unhealthy places to be. If you value your health, these towns aren’t doing you any favors:

1. Indianapolis, IN
2. Memphis, TN
2. Wichita, KS
4. Nashville, TN
5. Baltimore, MD
6. San Antonio, TX
7. Jacksonville, FL
8. Detroit, MI
9. Fort Worth, TX
10. Philadelphia, PA

In order to come up with this ranking, we worked with one of our largest sets of criteria to date. If you’d like to read how we figured it all out, and see some of the worst offenders in various categories, we’ve got you covered below— although you’ll probably want to go for a walk afterwards.

How We Did It

Like we’ve done for similar city rankings, we started with a list of the 50 most populous cities in the country. Then, we had to decide which criteria we thought would contribute to a city being generally unhealthy. We ended up with 12:

  • Fast food restaurants per square mile
  • Percentage of population that meets federal activity guidelines
  • Percentage of population with diabetes
  • Percentage of population that is obese
  • Percentage of population that smokes
  • Percentage of population with low access to healthy food
  • Air quality rating
  • Walkability score
  • People per recreation facility
  • People per farmers’ market
  • Park acreage per person

Of course, coming up with criteria is one thing; researching all of it is another. But that’s what we do here. Through that research, we inevitably come upon some surprising data—and that’s what you’ll find in our notes below, starting with the health of the residents in our 50 most populous cities.

Cities at Risk

Smog over Los Angeles

Photo: Flickr user Steven Buss

There are lots of criteria that can be used to gauge the health of a city’s residents. We looked at four specifically: the prevalence of diabetes, obesity, and smoking, plus the percentage of people that are getting the minimum amount of activity necessary to be healthy.

Our first stop was the U.S. Department of Agriculture (USDA), which collects data on some of the criteria we needed via its Economic Research Service. Two of these are the diabetes and obesity rates for counties throughout the country.

Diabetes and Obesity

Using the USDA data, we discovered that the city with the highest occurrences of both is Detroit. 12.3 percent of the people who live in Detroit have diabetes, while 34.2 percent are obese according to federal guidelines. Memphis has the second highest occurrence of diabetes and obesity, at 11.8 percent and 34.1 percent, respectively. Residents of Louisville, KY round out the top three with diabetes and obesity rates of 11.2 percent and 33.7 percent, respectively.

Physical Activity

In terms of cities where residents are taking simple steps to become healthier or stay healthy, namely meeting the government’s physical activity guidelines, Memphis and Nashville tied for worst according to the USDA. Only 49.2 percent of the people living in these cities are meeting the guidelines. Louisville came in a distant third-worst at 62.3 percent.


Then there are cities where people are actively doing something that puts their health at risk: smoking. According to the USDA, the city with the highest percentage of adult smokers is Indianapolis at 30.3 percent, followed by Cleveland, OH at 29.8 percent and Las Vegas, NV at 29.7 percent.

Air Quality

We also looked at air quality for this index, using ratings provided by the American Lung Association and its annual State of the Air survey. In its 2013 report, nine of our 50 most populous cities received an “F” rating:

The takeaway here: If you love your lungs, get out of Indianapolis. Not only is its air bad to begin with, but you have a greater chance of inhaling secondhand smoke there than anywhere else on our list.

On the flip side of the smoker data, it’s heartening that, even in the worst city, two-thirds of the residents are health conscious enough to know how dangerous smoking can be. They might even be trying to improve and maintain their health by exercising and taking part in outdoor activities. That’s why we decided to look at the how the cities fared in these criteria next.

Staying in Shape

Working out

Photo: Flickr user Lululemon Athletica

One of the things we knew was important in determining a city’s overall healthiness was access to gyms and other recreation facilities, as well as open space to stay active in and the ability to get to places just by walking.

Recreation Facilities

Using its data, we discovered that Philadelphia, PA is the worst when it comes to the availability of places to get some exercise, with only one per every 18,737 residents. El Paso, TX was next, with one per 13,050 people, and New York City, NY was third with one recreation facility for every 10,892 people.

Park Space

Park space is something we’ve looked at in previous top 10 city rankings we’ve done, and it seemed particularly applicable here. Based on the data we’d gathered in the past, Miami is worst in this regard, with only .0029 acres of park space per resident. Fresno and Chicago rank second- and third-worst with .0030 and .0044 acres per person, respectively.


If you’re not a fitness buff, the simple act of walking can be a boon to your health. With that in mind, we checked out the walkability of the cities using the trusty Walk Score website, which scores based on how easy it is to perform common errands on foot. Fort Worth, TX, Oklahoma City, and Nashville were tied in this category with walk scores of 36 (out of 100).

In cities at the other end of the scale—Philadelphia, for example, at 98—it’s easier to get to places like grocery stores on foot. This inspired us to look into how the cities on our list fared when it came to making eating healthy an option for residents.

Eating Right

Fresh veggies

Photo: Flickr user Danny O.

In recent years, there’s been more attention placed on so-called “food deserts”—areas where residents have to travel long distances to get fresh produce and other healthier food options from stores. We turned to the USDA to get an idea of where we could find the largest number of people faced with this sort of situation, and once again found it in data from the Economic Research Service.

Access to Healthy Food

We discovered that nearly a third of Kansas City, MO residents—29.99 percent—are without easy access to healthy food options. In Minneapolis, MN, 29.65 percent find themselves in that camp, while 29.57 percent of Cleveland residents do.

Farmers’ Markets

Since farmers’ markets offer an alternative to traditional grocery stores when it comes to buying fresh produce and other healthy food options, we used USDA data to determine how many of them there are in each of our 50 cities compared to their populations. Houston, TX did worst, with one farmers’ market for every 306,449 residents. Nashville has one for every 203,215 people while in Virginia Beach there’s one for every 110,677 residents. (Long Beach, at the opposite end of the spectrum, has an impressive one farmers’ market for every 3,666 people.)

Adding It Up

Once we had the data we needed, we ranked each city from 1 to 50 in the individual criteria, with 1 being the worst and 50 being the best. For criteria such as the obesity rate, a higher number resulted in a ranking closer to 1. Other criteria, such as walk score and the number of recreation facilities, were actually better the higher they got, so cities with lower scores in them were ranked closer to 1.

We then averaged the rankings across all 50 cities in order to get our final ranking of the 50 least healthy cities. As you saw above, Indianapolis took the top spot in the rankings, with Wichita and Memphis rounding out the top three.

We’re not saying everyone who lives in these cities is unhealthy, or that it’s not possible to get and stay healthy if you live there. But the data does show that there’s a higher chance your fellow residents aren’t in the best shape—and that you might have a harder time than most getting or staying healthy when compared to your chances of doing so in healthier places like Colorado Springs, CO (the healthiest city according to our data). Of course, any city is only as healthy as what’s in your fridge. (Or on your house, if you’ve wrapped it in bacon.)

Editor’s note: This article has been revised since its initial publication due to a statistical error affecting the park acreage criteria. Resolving it has slightly altered the final ranking, which is reflected at the beginning of the article.

Tile image: Flickr user Julie Bocchino

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posted on: May 21, 2013
28,100 views, 13 comments


  1. Mike in Omaha

    How did Va Beach be #1 in park acres in one of your surveys and 3rd worst in another? This is not a statistic which would change quickly.

    • Chris Kolmar in response to Mike in Omaha

      Thanks Mike. We revised the numbers in the article. We copy and pasted from the previous data set incorrectly.

  2. Natalie

    Nice. I’m surprised Houston didn’t make the cut. Gah.

  3. HuhWhat?

    Oh BS.

    I’m in the military and have travelled to KY, OK, CA, FL, VA, NC and now Indianapolis. Indy is incredible! Talk about parks and YMCAs, and things to do, outside…the air increible, the weather…

    Your stats lie! There is an incredible amount of things to do and I can’t drive anywhere without seeing multiple runners, bikers and walkers – all hours of the day, all days of the week!

  4. Teddywilde

    @HuhWhat? I live in Indy, but travel quite a bit, and this is spot on. Indy has made some improvement in the areas of parks and encouraging biking (i.e. the city as been re-doing roads to add bike lanes, the cultural trail is downtown, etc.), but overall, we are WAY down on the list when it comes to walkability and especially when it comes to overall wellness.

    I’m not sure where you come up with the weather being great here. My guess is that you’ve either a) have only been here in the summer, or b) live/stay near downtown or the Monon, which are really the only areas that have that lifestyle. Even though Indy is trying to get more active, the lack of access to healthy food and mass transportation (which encourages walking and to some extent, biking) has really held us back. And the number of people who smoke here is incredible.

  5. SJLawson

    Indy doesn’t get that the key to walk-ability is to get people out of their cars. I’m not sure where the author of this blog gets the second-hand smoke thing, though. Indy has a pretty good smoking ban. You have to really look for places that allow smoking inside (unless you just want a bar).

  6. Marge L

    New Orleans…. didn’t make the cut? HA!

  7. JWT

    I’m a little mixed on the study. True, Indianapolis has work to do to compensate for a healthier city, but there are plenty of gyms, parks, and places to bike. It took measures to cut out smoking in bars; it has added numerous health-oriented grocery stores like Whole Foods and Fresh Market. I think it depends on where you go and what people can afford. Living healthier isn’t cheap, and people I think can attest to that.

  8. Random

    Surprised to see Indianapolis taking first place. I’m from NYC, but work takes me to Indianapolis frequently and I’ve never noticed any of the negative things making up this list. I think the city sometimes gets a bad wrap, but my fellow east coasters and I always really enjoy our time there.

  9. Josh

    I totally agree with all the Indy support. I’m a displaced Hoosier in D.C. and Indy’s air quality is FAR better than here. My mom and brother were on pain killlers the whole time they visited because of the smog while they were here.

  10. Dave

    I don’t know how Cincinnati missed the list being practically next door to Indy and of the same ilk. Both those places abound in greasy spoon restaurants and unhealthy habits, in my opinion. (I go there 2-3 times per year and have spent several months at a time in Cincy.) I suffer greatly with fatty, salty, food and smoking patrons. For a while, until Friday’s and Olive Garden showed up, I couldn’t find anything except chili and barbecue. Maybe I’m just focused on the silly restaurants that travelers are stuck with. I’m from snooty Boston after all.

  11. John

    I have no idea how you claim all this to be true- I do know that if you had any belief in TRUTH in your writing and had any ounce of INTEGRITY in your writing you would personally find the facts before you write! Your statements about Indianapolis ( a 22 year resident in Indy) – I would say about 80% of what you put is way of base. They have a smoking ban- I very seldom see a smoker anymore- it is almost a suprise to see someone smoking here. Yes- we have a “fat” problem- but it has gone from one of the worst to middle of the pack now- major strides. Walking ability- geeez- we have a trail that reaches from way into southern parts of the state to the upper northern parts- tons of parks- tons of gyms. People everywhere are either walking , jogging, biking or some form of exercise. Yes- we could be a lot better- but you make it sound like we are the epitomize of the evil fat empire- and we are FAR FROM THAT! Air quality?? Have you ever been here??? The worse thing about our air is the allergens – no smog to fly into and breath later- no majorly smokey air- LA and several other big cities have it majorly worse then us- we actually have relatively clean air. My suggestion- take it personal- go to these cities and see for yourself- talk to the residents about the city- just dont compile data that as obviously not CONFIRMED because there is a LOT of wrong data in what you claim to be factual. You need to do your research before making such bold statements- and I see a LOT of people in the comments agree!

  12. Indianapolis Transplant

    This is spot on. If you want more perspective on Indy I would recommend reading this.


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