In some ways, Americans today are healthier than they were in 1990, when the United Health Foundation first published America's Health Rankings, an annual state-by-state assessment of our nation's health. Cardiovascular and cancer deaths are down, and the smoking rate has decreased 36%. Plus, life expectancy is at an all-time high—78.7 years. "But although we're living longer, we're also living sicker, with preventable illness at an alarming level," says Reed Tuckson, MD, external senior medical advisor to United Health Foundation. The number-one reason: Obesity. "Since 1990, the obesity rate went from 11.6% to 29.4%, a 153% increase," Dr. Tuckson says. In the last year alone, it rose 7%. Physical inactivity is also at a new high: 23.5% of Americans do not exercise at all.