The prevalence of obesity has increased substantially over the past 30 years. Obesity is a multi-factorial disorder, which is often associated with many other significant diseases such as diabetes, hypertension and other cardiovascular diseases, osteoarthritis and certain cancers. For these reasons, it is a complex health issue to address. The objective of this study is to identify the factors which are responsible for the spatial variation of adult obesity throughout the Appalachian region. In addition, preliminary examinations are made to identify potential associations between geographic variability in the prevalence of obesity and the characteristics of individuals and places with variable prevalence rates. Obese prevalence estimates were generated for all counties in Appalachia for adult males and females using data from the Behavioral Risk Factor Surveillance System (BRFSS). These data were used to create maps of obesity prevalence in Appalachia. Certain counties consistently experience higher prevalence of obesity for both genders. In areas with persistently high obesity prevalence rates, the burden is often highly localized among specific counties. A regression model was implemented to analyze the effect of a number of factors on obesity. Two significant contextual factors, employment change and labor force participation, were identified, even though they have not been addressed in the literature. The regression model results demonstrate poverty having a significant impact on female obesity, but no significant impact on male obesity. The regression model also found that urban-rural location is significant, but gender specific only for males in non-metro areas and small metro areas.