Marengo County ranks as the 10th-least healthy county in Alabama, according to a report released Tuesday by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation.

The report is the first to rank the overall health of the counties of all 50 states by using a standard formula to measure how healthy people are and how long they live.

Neighboring Perry County was ranked the least healthy county in Alabama, and six Black Belt counties rank among the bottom 10, including Greene (second), Dallas (sixth), Sumter (seventh) and Wilcox (eighth). Other counties among the bottom 10 include Walker (third), Lowndes (fourth), Bullock (fifth) and Fayette (ninth).

“I think that fast foods is one of the major problems,” said Betsy Adams, the director of the Wellness Center at Bryan W. Whitfield Memorial Hospital. “People live in a fast world now, and people want their food immediately. They eat the wrong things, and they get in the habit of eating the wrong things. They don’t exercise and they don’t plan ahead for what they’re going to eat. If they would plan ahead, they would eat a lot healthier. Good health habits snowball; so do bad health habits.

“In the South, too, people try to put the fat back into their vegetables. We try to get people to cook their vegetables without adding fat to them by cooking with bouillon, fat-free chicken broth or something like that. We try to teach them how to eat right and eat healthy.”

Adams works with the hospital’s Scale Back Alabama weight-loss program that features classes about eating and living healthy.

“A big part of that is portion control,” she said. “In America, our portions are too large. In other countries where you don’t see the prevalence of heart disease, their portions are much smaller. People here should ask for a take-home box at the beginning of the meal and go ahead and put some of that meal in the take-home box for another meal.”

Shelby County ranked as the healthiest county in the state, followed by Lee, Baldwin, Madison, Morgan, Limestone, Elmore, Houston, Coffee and Blount.

The report considers factors that affect people’s health, including health behavior, clinical care, social and economic factors and physical environment.

Health factors included rates of adult smoking, adult obesity, uninsured adults, high school graduation rate and access to healthy foods.