WASHINGTON — 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 Hawai'i and Colorado, there's little good news. In 31 states, more than one in four adults are obese, says a new report from the Trust for America's Health and the Robert Wood Johnson Foundation.

Obesity rates among adults rose in 23 states over the past year, and no state experienced a significant decline.

"The obesity epidemic clearly goes beyond being an individual problem," said Jeff Levi, executive director of the Trust, a nonprofit public health group.

It's a national crisis that "calls for a national strategy to combat obesity," added Robert Wood Johnson vice president Dr. James Marks. "The crest of the wave of obesity is still to crash."

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.

Health economists once made the harsh calculation that the obese would save money by dying sooner. However, recent research instead suggests that better treatments are keeping them alive nearly as long — but they're much sicker for longer periods. Medicare spends anywhere from $1,400 to $6,000 more annually on health care for an obese senior than for the non-obese, 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, at 32.5 percent, had the highest rate of adult obesity for the fifth year in a row.

• In 1991, no state had more than a 20 percent obesity rate. Today, the only state that doesn't is Colorado, at 18.9 percent.

• Hawai'i, at 21.8 percent, had the 47th-ranked obesity rate.

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