Morgantown, W.Va.— When Tom Terrarosa, a 21-year-old student at West Virginia University, first began eating on a college student budget, he gained about 60 pounds. He says he found it difficult to eat healthy on a limited budget.

“When you go into a grocery store and see Mac and Cheese for a dollar, of course you’re going to pick that over fresh produce,” Terrarosa says.

Limited budgets may also explain why many other West Virginians are overweight, with the percentage of state residents who are obese reaching over 30 percent, according to the Center for Disease Control. And with such weight gains come serious health problems. West Virginia currently ranks number one in the nation for the prevalence of diabetes, hypertension, heart attacks, and coronary heart disease among its residents and number two in the prevalence of arthritis, according, to a recent study by the West Virginia Department of Health and Human Resources.

State health officials say that poverty and long-engrained habits play a role in the poor health of many of the state’s residents. Low-income neighborhoods are filled with fast-food restaurants and convenience stores stocked with junk foods, says Lisa Lineberg, a nutritionist and exercise physiologist in Charleston, West Virginia. At the same time, many low-income parents who are working several jobs to make ends meet often don’t have time to prepare healthy, nutritious meals and they can’t afford to buy fresh local produce at farmers markets.

“A lot of people in poverty are overfed and undernourished,” Lineberg says. “They eat lots and lots of food, but the food they eat has poor nutritional value because it’s cheap.”

A McDonald’s in Morgantown, West Virginia is packed with hungry patrons on a Sunday afternoon.

“It’s a generational issue,” says Brooke Nissim-Sabat, a nutrition professor at Fairmont State University. “West Virginia has a history of high obesity rates, which means certain poor health habits have been passed down from parents to their children.”

Children have among the highest obesity rates in the state. Over 30 percent of low-income preschoolers in southern West Virginia are now considered obese, Nissim-Sabat says.

Cuts in public school funding also contribute to high obesity rates among West Virginia children, Lineberg says. Physical education classes in many schools have been cut from every day to only twice a week. Lineberg also notes that much of the food provided to children in West Virginia schools, including greasy pizza and french fries, is often low quality.

Because many West Virginians are poor, they don’t have adequate health insurance and access to health care. Indeed, one-fifth of West Virginia adults had no heath care coverage in 2010, according to the state Department of Health and Human Services. Many West Virginia residents don’t even have a primary care doctor and as a result, they don’t receive the care they need until their health problems worsen and they end up in emergency rooms. Getting care in an emergency room or other urgent care setting is far more expensive than getting preventative treatment by a primary care physician.

Obesity and the resulting health problems also carry a steep cost both to overweight individuals and to state coffers. On average, people who are considered obese pay 42 percent more in health care costs than normal weight individuals, according to the Weight-Control Information Network which provides the general public, the media and Congress with information on weight control.

The state has enacted certain initiatives to try to reverse the poor eating habits of many of its citizens. The Budget Bill passed in 2009 allows West Virginia residents who are on Medicare or food stamps to be able to use their government subsidies at local farmers markets. Nissim-Sabat hopes this will encourage obese individuals to buy more fresh and organic produce instead of processed foods.

One Big Mac from McDonalds has 540 calories, over one-fourth of your normal daily calorie intake.

The Be Healthy Now community initiative is possibly the best hope for West Virginians, according to the Center for Disease Control, which helped fund the program. This initiative focuses on increasing the number of grocery and convenience stores that offer fresh, healthy food, building more playgrounds, walking and bike trails in the state, and making sure children get more physical activity in schools.

This summer, WVU student Tom Terrorosa decided to do something about his own weight gain. He replaced processed foods and fast food with fresh vegetables, nuts and meats. He has since lost almost 40 pounds.

“Many people in West Virginia are not educated on how to eat properly,” he says.