Wodonga residents are punching above their weight compared to Albury, with 70 per cent of people considered overweight or obese.
Wodonga ranks 15th in the state for weight issues while Albury ranks 83rd in NSW.
Both cities are about six percentage points above their state averages.
New research from the Mitchell Institute at Victoria University shows the twin cities were home to 45,278 obese and overweight people in the 2014/15 financial year.
While Albury is only ranked 83rd in NSW for overweight or obesity rates, 69.7 per cent of residents are in that category.
Albury Wodonga Health dietician Jane Ford said there were many causes, including a lack of food knowledge, access to exercise facilities, and wide availability of food high in fat, salt and sugar.
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"We've got more food available to us in the Western world than we ever have, and we've got less incidental exercise in our day," she said.
"We sit at computers, drive to work, and use our phones or devices in our downtime."
While there are many walking tracks on the Border, Ms Ford said it was hard for many to walk or ride to work or school.
"I think when planning is done for any infrastructure in a town, there should be some ability for people to be able to exercise in that suburb and not always rely on cars or public transport to get us from A to B," she said.
Professor Rosemary Calder said wealthier areas had lower rates of obesity with more space dedicated to parks, gardens and recreational facilities.
Prof Calder said people in such areas could often to exercise to work, and said policy change was needed at every government level.
"We have spent too long as a nation expecting individuals to be able to change their behaviour to reduce their weight," she said.
"However, the evidence is very clear that this has little chance of success without a very strong focus on the environmental factors in the places where we live that contribute to poor nutrition and inactivity."
Areas with the highest rates of obesity also have much higher rates of smoking, inactivity and chronic illness.
"Local governments are critical to local planning and the creation of healthy and active spaces for their residents," Prof Calder said.
"However, they are often hampered by lack of funding and regulatory power."
Ms Ford said the health impacts of weight problems included diabetes, hip and joint problems, and complications with surgery.
"It's very hard to lose weight," she said.
"It's not just giving someone a diet sheet and saying 'get on with it'.
"You need to look their psychology, their ability to exercise and their motivation."
The statistics show 70.2 per cent of Alpine Shire residents are overweight or obese, 69.4 per cent in Indigo, 67.7 per cent in Wangaratta, 70.9 per cent in Corowa, and 69 per cent in Greater Hume.
Melton has the highest weight problems in Victoria, along with the Murrumbidgee region in NSW.