The Washington, D.C. metro area has held the top spot in the American College of Sports Medicine's annual American Fitness Index ranking of the United States' 50 most populous metropolitan areas for two years running. The report cites, among other things, the high average fitness level and healthy eating habits of residents, the widespread availability of health care and facilities such as swimming pools, tennis courts, and parks, low rates of obesity and tobacco use relative to the national average, and the high median household income as contributors to the city's community health.