Hawaii reclaimed its spot as the healthiest state in America despite significant disparities in the health of certain populations, including Native Hawaiians.

The America’s Health Rankings report by United Health Foundation listed Hawaii as among the best for low prevalence of obesity and mental distress relative to other states, as well as low levels of air pollution. The annual report examines behaviors, the community and environment, policy, clinical care and outcomes in measuring overall health. The Aloha State was No. 2 overall in the rankings last year after being first in the five previous years.

“Unfortunately, I don’t know that our rate of obesity has improved. I do know that the rate of obesity in many states on the mainland has actually worsened, so by comparison we look better,” said Dave Heywood, plan president for United Healthcare.

Obesity across the country reached an all-time high in this year’s report. For the first time, more than 30 percent of the adult population was found to be obese, up 5 percent from the previous year. The condition is a top contributor to chronic illnesses such as cancer, cardiovascular disease and diabetes.

“Unfortunately, for example, Native Hawaiians have a higher rate of obesity as well as diabetes, congestive heart failure and so forth,” Heywood said, adding that low-income populations also are more prone to health problems. “We’d probably be more middle- of-the-road if we compared ourselves to say, Western Europe.”

The report also took into account the state’s low uninsured rate, which dropped to 3.7 percent from 7.8 percent of the population over the past five years. Smoking also fell to 12.8 percent of adults from 16.8 percent in the past six years, while the number of primary care physicians rose to 187.6 from 172.6 per 100,000 population over the past two years. There is still, however, a significant shortage of doctors in the islands. And while tobacco use has declined, the use of e-cigarettes — known as vaping — has skyrocketed, particularly among local youth.

Hawaii’s other primary challenges include low immunization rates among adolescents; a high incidence of salmonella bacteria, a common cause of food poisoning; as well as excessive drinking, which rose to 21.1 percent from 19.7 percent of adults over the past five years. In the same time period, diabetes rose to 10.9 percent from 7.8 percent of adults.

“There’s a lot of things to be proud of relative to the rest of the country, but if you read some of the challenges listed, there’s always opportunity for improvement,” Heywood said.

After Hawaii the healthiest states are Massachusetts, Connecticut, Vermont and Utah. Louisiana had the worst health, followed by Mississippi, Alabama, Oklahoma and Arkansas.