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Maryland residents overall are healthier than they were last year, but on the downside, the state has seen a 122 percent increase in the obesity rate in just two decades, according to a recent report by a group that included the American Public Health Association.

Lawmakers have supported measures in the past — successfully and unsuccessfully — to legislate behavior by banning unhealthy fats, requiring menu labeling and mandating more exercise in schools.

However, at least one lawmaker is questioning whether the state will be able to respond to the growing obesity rate, because any legislation in 2010 likely would have a fiscal impact in the midst of what officials anticipate will be an extremely tight budget year.

The "America's Health Rankings" report, released last week by the American Public Health Association, Partnership for Prevention and United Health Foundation — the nonprofit arm of United Health Care, which is part of the United Health Group — had Maryland as 21st in the nation in overall health. That was an improvement from 2008, when the state ranked 26th.

The ranking considers rates of smoking, obesity, poverty, immunization, availability of doctors, the national census and other data.

Maryland is 25th in the nation in the prevalence of obesity, and the state has experienced a 122 percent increase in obesity from 12 percent of the population in 1990 to 26.6 percent in 2009, according to the report.

The county with the highest rate of obesity in Maryland was Somerset, on the lower Eastern Shore, where 47.1 percent of the population is obese, according to Audrey Regan, director for the office of chronic disease prevention for the state's Department of Health and Mental Hygiene.

The most current data is from 2007, she said.

Montgomery County had the lowest obesity rate in Maryland, at 16.8 percent.

For the past two years, Del. James W. Hubbard (D-Dist. 23A) of Bowie has introduced legislation that would ban restaurants from using trans fats, which have been proved to harm health. While those measures failed, Hubbard says he will introduce the bill again in the 2010 legislative session — this time with a twist.

Hubbard is working to expand the bill to not only ban trans fats statewide, but also require restaurants to print nutritional information on menus.

The Montgomery County Council passed a similar measure on menu labeling earlier this month, and a menu labeling requirement is part of national health care legislation being considered in the U.S. Senate.

Hubbard, who chairs the House Health and Government Operations' Public Health Subcommittee, said the labeling will tell customers "what are healthy foods and what aren't."

His trans fat ban would not apply to prepackaged food prepared outside the state, he said.

Hubbard says he believes the bill, which passed in the House in the last session but was not taken up in the Senate, will become law in 2010.

"Good bills take three or four years to go through," he said. "Bad bills take 90 days to pass.

"I'm like a dog on a bone — I don't give up," Hubbard continued. "I attack the subject, the policy issue."

Another thing that could be on Hubbard's side: It's an election year.

Senators who were resistant to voting on Hubbard's bill in the last session will be "looking a little deeper into how they vote," he said.

"It's a good bill," Hubbard said. "The Senate just didn't want to deal with it."

Del. Shirley Nathan-Pulliam (D-Dist. 10) of Baltimore has supported health-related bills in the past, including one that passed in 2008 to form a committee to study childhood obesity.

A report from that committee is required by Dec. 1 under the bill and will go to Gov. Martin O'Malley (D) and the General Assembly.

However, Nathan-Pulliam, a registered nurse, does not expect to introduce any legislation on obesity in 2010 because of the cost.

Del. Shane E. Pendergrass (D-Dist. 13) of Columbia says obesity is a "very big health problem."

She attended a recent PTA meeting in Howard County and heard about the need for more recess and physical education in schools. Pendergrass said she tries to walk as much as possible.

"We all need to do better. We need to watch what we eat, and we need to make sure we get some exercise," said Pendergrass, who is vice chairwoman of the House Health and Government Operations Committee.

She has supported efforts to reward people for healthy living, including allowing insurance companies to offer incentives.

However, there is a fine line between legislating and letting people make decisions on their own, Pendergrass said.

"I eat ice cream," she said. "I don't want a law telling me I can't eat ice cream, even though I know I probably shouldn't eat ice cream."