A new ranking from the United Health Foundation, the American Public Health Association and Partnership for Prevention analyzes the nation's health state-by-state. This year, the index found the American obesity rate increased and even more people were sedentary than in 2013.

In 2013, 27.6 percent of Americans were obese. This year, that number is 29.4 percent of adults. In addition, 22.9 percent said they hadn't exercised or engaged in physical activity in the last 30 days in 2013, and 23.5 percent said so in this year's index.

The healthiest states included Hawaii in the top spot, followed by Vermont and Massachusetts. Louisiana, Arkansas and Mississippi rounded out the list in the last three spots.

Diabetes in the rankings

Almost 10 percent of adults in America said they have diabetes this year, which is more than double what the figure was 20 years ago when the index began to concern itself with the disease, USA Today reports.

"What people are not focusing enough on is that we are producing an extraordinary number of people who are unnecessarily sick," Reed Tuckson, an Atlanta internist and senior medical adviser to United Health Foundation, tells USA Today. "They are pouring into the medical system; it's a total crisis."

Managing risk factors

Both obesity and a sedentary lifestyle are correlated with the <a href="http://www.diabeticconnect.com/diabetes-news/general/9873-link-among-obesity-diabetes-and-death-risk-is-complicated?utm_source=Articles&utm_medium=Internal+Link&utm_campaign=Related+footer" rel="nofollow">onset of diabetes symptoms, and the data from the health rankings report indicates many people around the country are at risk. People who are at a high risk for diabetes, and those who have prediabetes, need to be very careful with their lifestyles, but there are many factors that can impede efforts to live well.

Some of these factors are hard to control, like serious financial constraints - it's difficult to work several jobs and suffer food insecurity and manage somehow to have pristine nutrition and exercise habits. However, there are ways to work around these conditions, and people who have prediabetes or are at high risk and struggling in any way should look for community health services they can afford to help them maintain their wellbeing.

Other factors that make healthy living harder include depression and anxiety. When depressed or anxious, it's easy for people to make the choices that aren't as good for them but are easier. According to Dr. Mitesh Popat, writing for SF Gate, many people with diabetes have depression, and many of them don’t seek treatment. It can begin a sort of vicious cycle, in which people who have diabetes or are at risk for it make unhealthy choices due to depression, feel their health decline, feel more depressed as a result and make more unhealthy choices.

If you think you may be suffering from depression and have diabetes or prediabetes, it's very important that you talk to your doctor about your options. There are many things - from counseling and medication to free community support - that could help you break the cycle and improve your health, as the newly released index shows many Americans must do.

For more on diabetes risk factors:

The Obesity Paradox
Stopping Diabetes in it Tracks: Managing Prediabetes
Risk Factors for Prediabetes