Obesity, a risk factor for severe effects of COVID-19, continues to become more common, according to data released Thursday by the U.S. Centers for Disease Control and Prevention.

Twelve states now have a self-reported adult obesity prevalence of 35% or more, up from nine states in 2018 and six in 2017.

Those 12 states are Alabama, Arkansas, Indiana, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Oklahoma, South Carolina, Tennessee, and West Virginia. Pennsylvania’s adult obesity prevalence was 33%, and New Jersey did not have enough data for an estimate.

The data come from an ongoing, state-based telephone interview survey conducted by the CDC and state health departments.

Previously, the CDC reported that the national prevalence of obesity among adults was 42% in 2017–18.

In the United States and other developed countries, overweight and obesity have been increasing for decades, the result of changing diets, sedentary lifestyles, and genetic factors. The coronavirus pandemic has made the situation worse.

A study published in July suggests that daily activity has taken an unhealthy turn worldwide as people stay home and businesses are closed. Researchers at the University of California, San Francisco analyzed smartphone fitness tracker data and found a 5.5% global decrease in average daily steps, or about 287 fewer steps in the first 10 days after the World Health Organization (WHO) declared a pandemic on March 11. Thirty days into the pandemic, that average daily step count plummeted by 27.3%, or 1,432 steps.

As the CDC noted in Thursday’s report, the tolls of both obesity and COVID-19 are worse in minority groups:

Obesity worsens outcomes from COVID-19, increasing the risk of severe illness, hospitalization, and death," the report stated. “Obesity disproportionately impacts some racial and ethnic minority groups who are also at increased risk of COVID-19.”

”These disparities," the CDC said in statement, “underscore the need to remove barriers to healthy living and ensure that communities support a healthy, active lifestyle for all.”