Improvement in the overall health of Americans has stalled in the last five years as more people became obese and fewer quit smoking, according to a report released on Monday.

The America’s Health Rankings report, issued at the American Public Health Association’s annual meeting, showed that 23.1 percent of the U.S. population is now considered obese, more than twice the level in 1990.

It also found that while the number of smokers has fallen by almost a third since 1990 to the current level of 20.8 percent of the population, most of that decline came in the early 1990s with no significant drop between 1993 and 2003.

The report, combining 18 health indicators including smoking, infant mortality and immunization coverage, shows that while U.S. overall health improved by an average of 1.5 percent a year during the 1990s, the rate of increase has slowed to just 0.3 percent since 2000.

Tobacco use remains the biggest preventable cause of premature death in the United States, resulting in some 440,000 deaths from a variety of diseases each year, the report said.

The report was produced by the APHA, which represents public health professionals, along with the United Health Foundation and the Partnership for Prevention.

LIFE EXPECTANCY 69.3 YEARS

The United States now has an average life expectancy of 69.3 years. That figure is exceeded by 28 other countries, including Britain, France, and Germany, and is some five years less than in Japan, the report said. The U.S. infant mortality rate is also more than twice that in Japan.

The health record is also related to social and economic factors such as poverty and high school graduation rates, the report said. It found the number of children living in poverty increased in 25 states since the 2004 report, and that the high school graduation rate fell to 68.3 percent this year from 72.9 percent in 1990.

The report, which ranks the health of each U.S. state, gave the highest grade to Minnesota for the second year in a row. The worst ranking went to Mississippi, where the number of children in poverty rose 15 percent in the last year, and 29.4 percent of the population was obese.

The slower overall rate of health improvement mostly reflects obesity and smoking, said Dr. Reed Tuckson, vice president of United Health Foundation, a nonprofit research organization, in a conference call with reporters.

“This is not about more government money and heavy funding,” he said, calling on individuals and communities to adopt healthier lifestyles.

Tuckson added that increasing numbers of people without health insurance was a contributing factor. Since the 2004 report, the percentage of uninsured people has risen in 26 states and more than 15 percent of the population lacks health insurance, according to the report.