Smoking and obesity were rated the most significant risk factors affecting the health of Americans and the rising healthcare costs, according to the 2009 America’s Health Ranking report.

The report, a state-by-state assessment created by the American Public Health Association and United Health Foundation, found that of the $2.4 trillion spent on U.S. healthcare, $1.8 trillion is spent treating chronic illnesses such as diabetes, heart disease and cancer--conditions most commonly linked to tobacco use and obesity.

In 2009, 27 percent of the population was considered obese, and, according to the report, if this trend continues that number will skyrocket to 43 percent in 2018, with a whopping $80 billion in healthcare costs spent on obesity prevention and treatment.

According to the report, these numbers relating to obesity have jumped 130 percent since the first American Health Ranking was published 20 years ago.

Obesity has now grown to as much of a risk factor--if not greater--than smoking for death and disease in the U.S., according to the report.

Last year, tobacco use saw a dip of 1.5 percent, although 20 percent of the population are still smokers.

“Unless there is urgent action across our society, our already overburdened care system will be swamped by a tsunami of cost and demands from preventable chronic disease,” said Reed Tuckson, MD, board member, executive vice president and chief of medical affairs of United Health Foundation.

The study’s data measured health outcomes (infant mortality, cancer, cardiovascular and premature deaths), as well as health determinants (binge drinking, obesity rates, high school graduation rate and violent crime) on a state-by-state basis.

Results showed Vermont to be the overall healthiest state in 2009, followed by Utah, Massachusetts, Hawaii and New Hampshire. At the bottom end of the scale was Mississippi, which had high obesity rates (33.3 percent) and high cardiovascular disease deaths (378.5 deaths per 100,000 population), followed by Oklahoma, Alabama, Louisiana and South Carolina.

New York reported the biggest improvement of any state in the last 20 years due to a 60 percent drop in violent crime and a significant decline in the number of smokers (as a consequence of stricter rules, regulations and hefty cigarette taxes).

Data in the report was validated by the Centers for Disease Control and Prevention, according to the authors.