The percentage of Americans with bulging waistlines is growing in just about every state, with residents of Alabama joining the obesity ranks the fastest. Only Oregon failed to fatten, according to a report released Tuesday.

"Bulging waistlines are growing and it's going to cost taxpayers more dollars regardless of where you live," said Shelley Hearne, executive director of the Trust for America's Health.

The advocacy group, Trust for America's Health, said data from the Centers for Disease Control and Prevention showed that the percentage of obese adults for 2002-04 stood at 22.7 percent nationally. The percentage for the previous cycle, 2001-03, was 22 percent.

Alabama had the unhealthiest increase. There, the rate increased 1.5 percentage points to 27.7 percent. Oregon's rate held steady at 21 percent.

The report said the states with the highest percentage of obese adults are Mississippi, Alabama, West Virginia, Louisiana and Tennessee.

The states with the lowest percentage of obese adults are Colorado, Massachusetts, Rhode Island, Connecticut, Vermont and Montana. Hawaii was not included in the report.

While certain regions of the country fared worse than others, particularly the Southeast, the organization said that no state meets the federal government's goal of a 15 percent obesity rate for adults by 2010.

"Bulging waistlines are growing and it's going to cost taxpayers more dollars regardless of where you live," said Shelley Hearne, executive director of the Trust for America's Health.

Hearne said the United States is stuck in a "debate limbo" about how the government should confront obesity. She used the report to call for more government action on several fronts, such as ensuring that land use plans promote physical activity; that school lunch programs serve healthier meals; and that Medicaid recipients get access to subsidized fitness programs, such as aerobics classes at the local YMCA.

"We have a crisis of poor nutrition and physical inactivity in the U.S., and it's time we dealt with it," she said.

Radley Balko, a policy analyst at the Cato Institute, said he is wary of the call for more government action on obesity. The institute is a think tank that prefers free-market approaches to problems.

"I think obesity is a very personal issue. What you eat and how often you exercise, if that comes within the government's purview, it's difficult to think of what's left that isn't," Balko said.

Health policy analysts maintain that obesity increases the burden on taxpayers because it requires the Medicare and Medicaid programs to cover the treatment of diseases caused by obesity. The report issued Tuesday said taxpayers spent $39 billion in 2003 for the treatment of conditions attributable to obesity.

The Trust for America's Health recommended mandatory screening for obesity among Medicaid recipients, as well as nutritional counseling.

"Better prevention and disease management programs will result in cost savings to the system as a whole," the report stated.

Balko said it's not clear the government really knows how to persuade people to make better decisions. He said open-ended entitlement programs, such as Medicaid and Medicare, don't provide much of a financial incentive for people to watch their weight. The government just picks up the cost of treating diseases for those patients, regardless of the amounts, he said.

He prefers that the government give Medicaid and Medicare recipients an incentive to open medical savings accounts, which would allow them to save money when they did not access the health care system.

"If they knew they only had so much to spend, or what they did not spend could be saved, then maybe you could instill a certain sense of responsibility and ownership," Balko said.

Adults with a body mass index of 30 or more are considered obese. The equation used to figure body mass index is body weight in kilograms divided by height in meters squared. The measurement is not a good indicator of obesity for muscular people who exercise a lot.