According to a new study in the American Journal of Preventive Medicine, the Centers for Disease and Prevention Control (CDC), has identified geographic region now known as the “diabetes belt” in the United States that includes 644 counties across 15 states. While 8.5% of the U.S. population has diabetes, in this new region the number is 12%. The diabetes belt also includes a population that is 32.9% obese (compared to the national average of 26.1%), and 30.6% who do not exercise regularly (compared to a national average of 30.6%).

The diabetes belt includes counties in Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia and West Virginia, as well as the entire state of Mississippi. According to Dr. Shubhada Jagasia, associate professor of medicine at Vanderbilt University Medical Center in Tennessee, the counties that make up the diabetes belt are located in regions that used to be primarily agricultural, but are no longer. “People in those states may have continued to consume high-calorie foods, which are appropriate for heavy manual labor as is involved in agriculture, but very inappropriate if people eating that diet are now very sedentary.”

According to the CDC, in the United States almost 26 million people have diabetes, and 79 million people have prediabetes.