A new study shows tribal obesity in Arizona is the worst in the nation.

The report from the Trust for America’s Health says four of every five adult Native Americans in the state were obese or overweight in 2013. That’s the highest rate of any state in the country.

The report does not break down the numbers any further by listing the number of Native Americans considered obese and those who were overweight. By way of comparison, Cronkite News reports 64-percent of the overall state population were obese or overweight in 2014.

Advocates say they’re not surprised by the numbers, pointing to the unavailability of fresh and healthy food and a lack of access to health care services for many Native Americans in Arizona. 

Texas had the lowest rate with 51.6 percent of its native population considered obese or overweight.