You're overweight and you smoke. Both conditions are damaging your health. What should you conquer first: late-night visits to the fridge or smoking breaks during the day?

Quit smoking, then tackle the weight. "It's very difficult to do both at the same time," says Dr. Robert H. Eckel, professor of medicine at the University of Colorado Health Sciences Center and chairman of the American Heart Association Council on Nutrition, Physical Activity and Metabolism. "It's biologically hard. A physician or health-care professional who addresses both at once is really fooling themselves." An estimated 64 percent of Americans are overweight or obese, and 25 percent of the U.S. population smokes. No agency has overlapped the numbers to get a count of how many overweight Americans smoke , but there is no doubt that having both risk factors is a dangerous double whammy. "This is a bad combination," Eckel says. "There are a lot of bad combinations in medicine, but this is a particularly bad one. Kind of an alarming situation, clinically. "A smoker who's obese needs to realize they are complicating their risk profile." The recent report from the Centers for Disease Control and Prevention saying that if current trends persist, obesity would overtake smoking as the nation's No.1 cause of death, is doubly daunting for overweight smokers. "It plagues me every day," says Rochelle Vessels, 44, taking a drag of her cigarette on a break from her job at a downtown Denver financial firm. "I hate the fact that I'm still smoking and I hate the fact that I'm overweight." People with a body mass index (BMI) of 30 or higher are classified as clinically obese. Risks associated with obesity include heart disease, high blood pressure, stroke, high cholesterol, diabetes, some forms of cancer, arthritis and asthma. Obese adults have a 50 to 100 percent increased risk of premature death. Even being moderately overweight pushes risk factors higher. Add smoking, and now lung cancer, more heart disease and emphysema come into the picture. Smoking constricts the arteries. A fatty diet clogs them. Combine the two, and a person is a walking time bomb. "It's a very bad marker, especially for women. We don't know exactly why," says Dr. Richard E. Collins of South Denver Cardiology Associates in Littleton, and director of prevention and wellness at the South Denver Heart Center. "If you have both it does increase the risk and it is exponential." Collins says he does not see very many patients who are overweight and also smoke. "A lot of people smoke to prevent themselves from gaining weight. They use that as a justification. People who smoke and are also overweight ... need professional help. They've got things going on in their lives that are keeping them from enjoying a good lifestyle, whether it's stress or something else." For Pamela Norwood of Denver, stress plays a large role in her decision to smoke and not lose weight. The 42-year-old office manager from Denver says every time she tries to quit cigarettes, the stress overwhelms her. "My husband is disabled," she says. "There's just a lot I have to deal with. I'd like to quit (smoking). I think about it every day. I'm sick and tired of feeling sick and tired." Collins says there is a way out of the cycle. It's one step at a time. "Get yourself off cigarettes, then concentrate on the long-term weight loss. You can quit smoking right now and within a few months your risks start dropping dramatically. If you're overweight, it's going to take awhile." Eckel agrees. "For heart-attack risk, it's the active smoking candidates at most risk," he says. "Stop smoking, and in six months the risk factors plummet. You may eat more and gain weight at first, but after six months, at that point, then take a serious approach to the weight problem." Eckel says he saw a patient on a recent morning "who perfectly fits that profile." Asked if the man was trying to lose weight, quit smoking or both, Eckel has a rueful reply. "No. He's not trying to do either one. I do my best!"

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