News Release

Poor diet and physical inactivity may soon overtake tobacco as leading cause of death in U.S.

Peer-Reviewed Publication

JAMA Network

NOTE: The embargo for the following JAMA news release, "Poor Diet and Physical Inactivity May Soon Overtake Tobacco As Leading Cause of Death In U.S.", has been changed to 2 p.m. (ET), Tuesday, March 9, 2004, to coincide with a news conference being held by HHS Secretary Tommy Thompson and CDC Director Dr. Julie Gerberding, one of the authors of the JAMA study. The news conference will release the findings of the JAMA study and launch a new campaign on healthy living. The JAMA news release follows.

About half of all deaths in the U.S. can be attributed to largely preventable behaviors and exposures, with tobacco use and poor diet/physical inactivity accounting for the majority of preventable deaths, according to a study in the March 10 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, quantifying modifiable behavioral risk factors, which are the leading causes of death in the United States, will provide insight into the effects of recent trends and indicate missed prevention opportunities.

Ali H. Mokdad, Ph.D., and colleagues from the Centers for Disease Control and Prevention, Atlanta, conducted a study to identify and quantify the leading causes of death in the United States. The study included a comprehensive MEDLINE search of English-language articles that identified epidemiological, clinical, and laboratory studies linking risk behaviors and mortality (death). Prevalence and relative risk were identified during the literature search. The researchers used 2000 mortality data reported to the Centers for Disease Control and Prevention to identify the causes and number of deaths. The estimates of actual cause of death were computed by multiplying estimates of the cause-attributable fraction of preventable deaths with the total mortality data.

The researchers found that the leading causes of death in 2000 were tobacco (435,000 deaths; 18.1 percent of total U.S. deaths), poor diet and physical inactivity (400,000 deaths; 16.6 percent), and alcohol consumption (85,000 deaths; 3.5 percent).

Other actual causes of death were microbial agents (i.e., influenza and pneumonia, 75,000), toxic agents (exposure to pollutants, asbestos, etc., 55,000), motor vehicle crashes (43,000), incidents involving firearms (29,000), sexual behaviors (20,000), and illicit use of drugs (17,000).

"The rapid increase in the prevalence of overweight means that this proportion is likely to increase substantially in the next few years. The burden of chronic diseases is compounded by the aging effects of the baby boomer generation and the concomitant increased cost of illness at a time when health care spending continues to outstrip growth in the gross domestic product of the United States," the authors write. "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."

(JAMA. 2004;291:1238-1245. Available post-embargo at


In an accompanying editorial, J. Michael McGinnis, M.D., M.P.P., of The Robert Wood Johnson Foundation, Princeton, N.J., and William H. Foege, M.D., M.P.H., of the Bill and Melinda Gates Foundation, Seattle, write that continued progress on reducing preventable causes of death depends on a strong and vibrant public health capacity and working with the solid support and involvement of medical practitioners.

"Several priorities seem clear at this point. Because a substantial proportion of early deaths among the U.S. population is preventable through lifestyle change, the social commitment to making those changes possible must be enhanced considerably. Decisions about whether to smoke, how much to drink, how much and what kinds of food to consume, and activities in which to engage are the result of strong cultural and commercial signals. Unless strategies are specifically designed to address and improve the clarity and utility of these messages, U.S. society will fall far short of the possible," they write.

"Refining insights into the root causes of illness and injury, presenting those insights in a fashion that can motivate and guide effective action, and marshaling the effort to monitor the results of these actions will require steady improvement in the knowledge base. National leadership and commitment at the policy level, such as suggested by Mokdad and colleagues, is an important ingredient for progress. If the nation can heed the insights they share, acceleration of the attention and action necessary for progress ought to be anticipated. After all, 'Wisdom is knowing what to do next. Virtue is doing it'", they conclude.


(JAMA. 2004;291:1263-1264. Available post-embargo at

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