A GP in an area of Kent with some of the highest rates of obesity in England has blamed "pockets of poverty".
A so-called "fat map", released by analysts Dr Foster, said 9.4% of people in Medway were obese.
Dr Julian Spinks said it was difficult to identify the cause, but that the level of poverty in the region could be to blame.
Medway Primary Care Trust (PCT) said there was already a great deal of work being done to tackle the problem.
The map of obesity hotspots compiled from GP records puts Shetland, parts of Wales and northern England at the top.
England's fattest town is Barnsley, South Yorkshire, where 10.8% of people are obese.
In the South East, Hastings and Rother PCT follows Medway in the league table, with 8.7% of people obese.
Eastern and Coastal Kent PCT has 8.3%.
Slimming classes
Dr Spinks said that, if anything, the figures under-estimated the problem.
Diane Letts, 66, who weighs 15st, said she had been overweight since she was a child.
She used to attend slimming classes but could no longer afford them.
"When you get down and get depressed you are tempted to eat all the wrong things - you tend to say, I'll start the diet tomorrow," she said.
A spokesman for Medway PCT said obesity had been identified as one of the key areas of improvement locally.
It said a Healthy Weight Team had been established to support Medway's residents in achieving a healthy weight.
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