Think Americans are fat now? After all, a third of us are overweight and another 35 percent are obese. But a report out Tuesday projects 44 percent of Americans will be obese by 2030.

In the 13 worst states, 60 percent of the residents will be obese in less than two decades if current trends continue, the report from the Trust for America’s Health projects. That’s not chubby or a little plump – that’s clinically obese, bringing a higher risk of heart attacks, strokes, diabetes, several forms of cancer and arthritis.

“The initial reaction is to say, ‘Oh it couldn’t be that bad’,” says Jeff Levi, executive director of the Trust for America’s Health. “But we have maps from 1991 and you see almost all the states below 10 percent.” By 2011 every single state was above 20 percent obesity, as measured by body mass index (BMI), the accepted medical way to calculate obesity. Those with a BMI or 30 or above are considered obese.

In August, the Centers for Disease Control and Prevention reported that 12 states have an adult obesity rate over 30 percent. Mississippi had the highest rate of obesity at 34.9 percent. On the low end, 20.7 percent of Colorado residents are obese. CDC projections for obesity resemble those in Tuesday’s report - it projects 42 percent of adults will be obese by 2030.

The problem isn’t just cosmetic. “The number of new cases of type 2 diabetes, coronary heart disease and stroke, hypertension and arthritis could increase 10 times between 2010 and 2020 - and then double again by 2030,” the report projects.  “Obesity-related health care costs could increase by more than 10 percent in 43 states and by more than 20 percent in nine states.”

That’s bad news when states are already strapped to pay for public health programs such as Medicaid and the federal government is struggling to fund Medicare.