When an obese, inactive, middle-aged person dies from a heart attack, the cause of death is listed as cardiac arrest or heart disease. But a recent study published in the Journal of the American Medical Association (JAMA) would attribute the actual cause to a poor diet and inactivity. Chronic conditions-such as heart disease, cancer, stroke, and diabetes-are generally cited as the causes of death because they represent the major condition identified at the time of death. However, these conditions actually result from a combination of risk factors, some of which may have been controlled by the individual-such as smoking, diet, and inactivity. When nongenetic, or external, factors contribute to death, the deaths are considered to be premature. But premature mortality represents only one cost. A second type of cost is associated with a deterioration in the quality of life, which often precedes premature mortality. Identification of the external risk factors-those that potentially can be modified by the individual-would aid preventive efforts, improve the quality of life, and reduce health care costs. To this end, the JAMA study calculated the number of deaths according to the underlying risk factors, rather than to the condition itself.