Comparing 7 of the Least Healthy Cities in the Entire U.S.

Are some American cities less fit and more unhealthy than others? The data says absolutely.

The American College of Sports Medicine's (ACSM) American Fitness Index serves as a comprehensive measure of the health and fitness levels across the United States' 100 most populous cities. By evaluating a variety of indicators, the Index provides a detailed overview of how conducive each city is to promoting an active and healthy lifestyle.

The rankings of these cities underscore the critical role that city planning, community investment, and public health policies play in shaping the well-being of residents. We're diving into ten cities identified as being in the poorest shape according to the latest ACSM Fitness Index.

We'll analyze the factors contributing to these rankings, including socioeconomic challenges, infrastructure deficits, and health behavior trends. By examining these case studies, we aim to shed light on the systemic issues affecting urban health and explore potential avenues for intervention and improvement.

This post was updated on August 15th, 2025, to reflect additional information.

To elaborate on the American Fitness Index, this data evaluates the 100 largest U.S. cities based on health behaviors, environmental factors, recreational infrastructure, chronic disease rates, and policy support to highlight disparities and drive improvements in urban health. Let's tale a look at the methodology before diving into the unhealthiest cities in America.

Each city’s score reflects a weighted analysis of individual health metrics, such as obesity, physical activity, and disease rates, alongside environmental and community features like bike lanes, parks, air quality, and public funding for health initiatives.

Arlington, VA was named the fittest city in America for the seventh straight year, followed by Washington, D.C. and Seattle, WA, thanks to widespread public support for healthy living, strong infrastructure, and high participation in physical activity.

Cities ranked at the bottom often share common challenges, including high obesity rates, low exercise participation, poor access to recreational facilities, and socioeconomic conditions that create barriers to healthier lifestyles. These are the lowest-ranking cities and why their populations are deemed so unfit.

Ranked dead last at 100, Oklahoma City struggles with pervasive health issues such as obesity, heart disease, and a lack of infrastructure supporting exercise, despite ongoing efforts to invest in new recreational spaces.

North Las Vegas ranked 99th due to poor walkability, low access to parks, and high levels of sedentary behavior, all contributing to widespread physical inactivity and poor health outcomes among residents.

With a low ranking driven by high obesity and smoking rates, Tulsa faces difficulty overcoming systemic health issues despite community outreach and expanding access to fitness initiatives.

Toledo’s ranking reflects a high incidence of chronic conditions, poor air quality, and limited fitness infrastructure, contributing to one of the least healthy urban populations in the U.S.

Indianapolis struggles with inactive lifestyles, limited pedestrian infrastructure, and suburban sprawl that discourages walking or biking, all of which contribute to its poor health profile.

Louisville ranks poorly due to high rates of smoking and obesity, along with a lack of easily accessible public parks or fitness amenities, though recent efforts aim to revitalize its health programming.

Bakersfield faces dual challenges of poor air quality and insufficient health infrastructure, limiting outdoor activity and contributing to high obesity rates and low fitness levels.

To improve rankings, cities must invest in public health education, recreational spaces, and active transportation while tackling socioeconomic barriers and promoting community-wide participation in wellness programs. However, funding isn't in the city's favor these days. Only time will tell if these unhealthy cities maintain their unfit standings.