Mississippi's still king of cellulite, but an ominous tide is rolling toward the Medicare doctors in neighboring Alabama: obese baby boomers.

It's time for the nation's annual obesity rankings and, outside of fairly lean Colorado, there's little good news. Obesity rates among adults rose in 23 states over the past year and didn't decline anywhere, says a new report from the Trust for America's Health and the Robert Wood Johnson Foundation.

And while the nation has long been bracing for a surge in Medicare as the boomers start turning 65, the new report makes clear that fat, not just age, will fuel much of those bills. In every state, the rate of obesity is higher among 55- to 64-year-olds _ the oldest boomers _ than among today's 65-and-beyond.

That translates into a coming jump of obese Medicare patients that ranges from 5.2 percent in New York to a high of 16.3 percent in Alabama, the report concluded. In Alabama, nearly 39 percent of the oldest boomers are obese.

Health economists once made the harsh financial calculation that the obese would save money by dying sooner, notes Jeff Levi, executive director of the Trust, a nonprofit public health group. But more recent research instead suggests they live nearly as long but are much sicker for longer, requiring such costly interventions as knee replacements and diabetes care and dialysis. Studies show Medicare spends anywhere from $1,400 to $6,000 more annually on health care for an obese senior than for the non-obese.

"There isn't a magic bullet. We don't have a pill for it," said Levi, whose group is pushing for health reform legislation to include community-level programs that help people make healthier choices _ like building sidewalks so people can walk their neighborhoods instead of drive, and providing healthier school lunches.

"It's not going to be solved in the doctor's office but in the community, where we change norms," Levi said.

The Centers for Disease Control and Prevention has long said that nearly a third of Americans are obese. The Trust report uses somewhat more conservative CDC surveys for a closer state-by-state look. Among the findings:

_Mississippi had the highest rate of adult obesity, 32.5 percent, for the fifth year in a row.

_Three additional states now have adult obesity rates above 30 percent, including Alabama, 31.2 percent; West Virginia, 31.1 percent; and Tennessee, 30.2 percent.

_Colorado had the lowest rate of obese adults, at 18.9 percent, followed by Massachusetts, 21.2 percent; and Connecticut, 21.3 percent.

_Mississippi also had the highest rate of overweight and obese children, at 44.4 percent. It's followed by Arkansas, 37.5 percent; and Georgia, 37.3 percent.

_Following Alabama, Michigan ranks No. 2 with the most obese 55- to 64-year-olds, 36 percent. Colorado has the lowest rate, 21.8 percent.

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On the Net:

Trust for America's Health: http://healthyamericans.org/

Robert Wood Johnson Foundation: http://www.rwjf.org/