1. Huntington-Ashland, W.Va.-Ky.-Ohio
2. Charleston, W.Va.
3. Kingsport-Bristol-Bristol, Tenn.-Va.
4. Columbus, Ga.-Ala.
5. Redding, Calif.
6. Fort Smith, Ark.-Okla.
7. Clarksville, Tenn.-Ky.
8. Chattanooga, Tenn.-Ga.
9. Spartanburg, S.C.
10. Little Rock-North Little Rock-Conway, Ark.
The home to the Ironman competition, the U.S.A. Cycling championships, and the largest downtown climbing complex in the country has also just been named one of the least healthy cities in America.
On Monday, a USA Today report counted Chattanooga as eighth-worst among America's least healthy cities, a designation based factors ranging from physical and emotional health to work environments.
The study underscores a disconnect between the city's cultivated image as an outdoor sports destination and a magnet for young, active entrepreneurs and a harsher reality that persists for many regional residents.
According to the USA Today report, based on the latest Gallup-Healthways Well-Being Index, 31 percent of residents said health problems hindered their ability to take part in activities typical for their age. Fewer than 80 percent said they had enough energy to accomplish what they needed to the day before, "worse than all but two other metro areas [nationwide]."
"For many people who are going to relocate to this community, it is a magnificent place to live," said Rae Young Bond, the executive director of the Chattanooga-Hamilton County Medical Society.
"But we have to remember that right now it is not a magnificent place for everyone. We can't lose sight of those in disadvantaged neighborhoods, where there are great disparities in access to the things that make this such a beautiful place to live."
The Gallup-Healthways Well-Being Index ranks 189 cities according to their "overall well being," measuring residents' physical and emotional health along with access to basic health care needs and quality of work environments.
"This report in many ways shows how people view their state in life and their future," said John Bilderback with Step ONE, the Hamilton County Health Department's initiative to battle obesity and promote fitness.
The survey was compiled from hundreds of thousands of responses gathered in 2012 and 2013, and is meant to "inform and prioritize tangible policies" for city and business leaders, study leaders said.
The Chattanooga Metropolitan Statistical Area - which includes six counties in Southeast Tennessee and North Georgia - was named 11th-worst for overall well-being.
Among states, Georgia ranked 27th in overall well-being, Alabama ranked 47th and Tennessee was 44th.
Financial news corporation 24/7 Wall Street took best and worst scores from the index, then factored in 2012 income, poverty and educational attainment data from the U.S. Census Bureau to create its "bottom 10" list of America's least-healthy cities for the USA Today report.
Chattanooga was joined in the bottom 10 by two other Tennessee cities - Clarksville, at seventh worst, and Kingsport-Bristol, third worst.
The report also indicated that low incomes in the region - where median household income was $43,475 compared to the national rate of $51,371 - hampered Chattanoogans' access to health care.
Three-quarters of respondents said they had enough money for health care and medicine - among the lowest rates nationwide, the analysis found.
"Most of the health-related economic reasearch shows that health is tied to income. It's a big barrier for Chattanooga, along with many other Southeast cities, where more people are living below the poverty line," said Dr. Gary Liguori, head of the University of Tennessee's Department of Health and Human Performance.
Poor health also takes a toll on the state's budget, said Rick Johnson, director of the Tennessee Governor's Foundation of Health and Wellness, which was launched last fall to fight the state's dire health statistics.
The state spends $6 billion a year to treat behavior-related disease, accidents and trauma, and 30 cents out of every dollar of Tennessee's budget is put towards health.
Johnson called the spending unsustainable.
"People in Tennessee need to see this as an important an issue as education and job creation. We're paying such a price," he said.
State health leaders say they are focusing on changing behaviors.
"We're not ranked in the bottom 10 because of an outbreak of some unknown virus without a cure," said Johnson. "It's because of our health-related behaviors. We can fix those."
In January, the foundation launched HealthierTn.com, an interactive website. It allows Tennesseans to track relatively small changes to their diet and exercise and smoking habits, with the goal that the "Small Starts" - as the tool is called - will turn into lifestyle changes.
There's a "Small Starts @ Work," too, which tailors the program for employers and has 75 businesses signed up as of this week. "Small Starts at Worship" will be launched in a few weeks.
But the report also stresses that city leaders are critical to embracing and sustaining a culture of well-being.
Bond said serious health disparities are ingrained in the region and will persist until the community "doubles down" to address them.
That might include things like making more walkable communities and ensuring neighborhoods have access to grocyer stores, the experts said.
Bilderback and Liguori both said Chattanooga will have to work to overcame this negative designation in the same way it famously overcame being the "dirtiest city in America."
Results could take decades, but foresight is "critical," said Liguori.
"You have to think ahead. You can't just hope that things will change.'"
Contact staff writer Kate Harrison at firstname.lastname@example.org or 423-757-6673.