For every American who died in the year 2000 because he got too high, more than 20 Americans died because they got too fat. That's according to the Journal of the American Medical Association (JAMA), which Wednesday published "Actual Causes of Death in the United States, 2000," a study of "modifiable behavioral risk factors" that kill people. The study reported 2.4 million deaths in 2000 and found that nearly half of them were related to lifestyle or other risky behavior, which in this study includes getting killed in a car wreck or murdered.

Not surprisingly, the leading lifestyle killer is tobacco, which accounted for more than 18% of all deaths that year, but sloth and piggery are running a close second and threaten to surpass tobacco, JAMA reported. Here are the lifestyle killers in rank order:

tobacco: 435,000 deaths
poor diet and physical inactivity: 400,000
alcohol: 85,000
microbial agents: 75,000
toxic agents: 55,000
motor vehicle crashes: 43,000
firearms deaths: 29,000
sexual behaviors: 20,000
illicit use of drugs: 17,000

"We found that about half of all deaths that occurred in the United States in 2000 could be attributed to a limited number of largely preventable behaviors and exposures," the authors commented. "Our findings indicate that interventions to prevent and increase cessation of smoking, improve diet, and increase physical activity must become much higher priorities in the public health and health care systems.

"The most striking finding was the substantial increase in the number of estimated deaths attributable to poor diet and physical inactivity," they continued. "The gap between deaths due to poor diet and physical inactivity and those due to smoking has narrowed substantially. "It is clear that if the increasing trend of overweight is not reversed over the next few years, poor diet and physical inactivity will likely overtake tobacco as the leading preventable cause of mortality."

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