Abstract This study explores the relationship between adult obesity prevalence and obesity-related state policymaking in the United States. We examine whether 2009 obesity prevalence and the change in prevalence between 2000 and 2009 are associated with obesity-related state laws and regulations introduced or enacted between 2009 and 2011. Policies that exclusively target youth are eliminated from our analysis. Adult obesity prevalence increased in all 50 states over the decade studied, with a slight decrease in Washington, DC. Increases in prevalence are significantly associated with fewer policies in the South and Midwest Census regions and the East North Central and South Atlantic Census divisions. Findings suggest the need for greater advocacy and an opportunity for obesity to rise on state policy agendas.