Fewer Americans are lighting up cigarettes, but too many of them are still laying around the house and getting heavier, according to an annual snapshot of the nation's health issued Wednesday.
Still, life expectancy in the U.S. is now at an all-time high, at 78.8 years, according to the America's Health Rankings survey.
That report found that the long-term decline in smoking rates among adults continued in 2014, with a 3 percent drop in people who say they puff regularly.
As of now, just 19 percent of U.S. adults smoke, compared with 29.5 percent when the report first started tracking data on smoking and a slew of other health, environmental and socioeconomic-related metrics in 1990.
However, after seeing a slight improvement in the obesity rate last year, that measurement increased again in 2014, continuing a disturbing upward trend over the past 25 years as obesity became a leading contributor
This year, 29.4 percent of adults were considered obese, up from 27.6 percent last year, according to the report, which is put out by the United Health Foundation, a not-for-profit group established by UnitedHealth Group.
In 1990, the obesity rate was just 11.6 percent among adults.
Not surprisingly, the ballooning waistlines come amid an increase in the number of adults who reported no participation in any physical activity during the year, from 22.9 percent last year, to 23.5 percent in 2014.
"Obesity continues to rise, physical inactivity continues to rise. Those two in combination are leading to a swell in chronic conditions," said Rhonda Randall, senior advisor to the United Health Foundation and chief medical officer and executive vice president of UnitedHealthcare Retiree Solutions.
"The one that concerns us the most is diabetes," said Randall, a doctor of osteopathic medicine.
The report found that self-reported cases of diabetes reached 9.6 of adults in the U.S., more than double the rate seen 20 years ago.
"That's just the tip of the iceberg," said Randall, noting that the actual rate of diabetes is much higher because many people are unaware they have the disease.
The foundation's reports did find some bright spots.
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Infant mortality dropped 4 percent since 2013, and now stands at 6.0 cases for every live 1,000 births, a 41 percent decrease since 1990. However, the current rate is still double the infant mortality incidence in a number of developed countries.
Immunization coverage for adolescents grew by 5 percent in the U.S. over last year.
Over the past 25 years, the report noted, cardiovascular deaths dropped by 38 percent, and premature death decreased 20 percent.
The report also broke out statistics for individual states, and ranked them.
Hawaii for the third year in a row took the top position as the healthiest state in the nation. The Aloha State, which benefits from a low rate of smoking, obesity, children living in poverty, and rates of preventable hospitalizations and cancer deaths, has never placed below sixth place since the rankings began being compiled in 1990.
Taking the next top five places, in order after Hawaii, were Vermont, Massachusetts, Connecticut and Utah.
Conversely, Mississippi took last place in the ranking for the third straight year. Mississippi, which has never risen from the bottom three states since the report began, has very high rates of obesity, physical inactivity, diabetes, children in poverty and infectious disease.
"Mississippi also ranks 50th for all health determinants combined, so its overall ranking is unlikely to change significantly in the near future," the report noted.
Just above Mississippi, in ascending order, were Arkansas, Louisiana, Kentucky and Oklahoma.
Randall said she hopes public health officials, government leaders and advocates in all the states look at the rankings and see what areas need improvement, and which states have been able to move up their ranks.
She noted that New York in the past 25 years has moved from 40th place to 14th place as the rates of infant mortality, premature death and violent crime have all fallen in the Empire State during that time.
While the report does not identify the causes for changes in the relative rankings, Randall said things like the steep decline in smoking use are an example of how officials and others can change behavior through different strategies.
"We can do the same thing with physical activity and diabetes if we put our mind to it," she said.