If Texans don't shape up, their preventable chronic diseases will cost $332 billion a year by the 2020s, according to a study released Tuesday.

Almost 12 million Texans suffered from preventable chronic diseases such as diabetes, high blood pressure and heart disease in 2003, the most recent year in the study by the Milken Institute.

Only Californians fared worse based on total numbers, with 16.3 million cases of such common chronic diseases there, according to the institute, an economic think-tank based in Santa Monica, Calif., and co-founded by former junk bond buyout specialist Michael Milken.

Still, taking into account Texas' large population, the state's incidence of disease was relatively low. It ranked in the best 25 percent of the 50 states.

The seven "most common chronic diseases" cited in the study – diabetes, hypertension, stroke, heart disease, pulmonary conditions, mental disorders and certain cancers – cost the nation more than $1 trillion a year in 2003, according to the institute. The tab could balloon to nearly $6 trillion by the middle of the century, it added.

In Texas, the cost of treating these illnesses came to $17.2 million in 2003, the report states. That's without considering the secondary health problems they cause.

Here, the most common of the seven preventable illnesses studied is pulmonary problems – 3.9 million cases, or 18 percent of the total – followed by hypertension, with 2.7 million cases, or 12.5 percent.

These conditions also reduce productivity in the workplace, as sick employees and their caregivers are forced to either miss workdays or perform under par when they do show up. The Milken study places a dollar figure on this reduced labor supply and its impact on GDP.

The cost in Texas comes to $75.3 billion annually, according to the study.

Some local companies are taking steps to reduce incidences of such diseases.

Fort Worth-based American Airlines Inc. – which has 25,000 employees in North Texas – purchases WebMD health program subscriptions for its employees, makes available a "nurse advocate" to answer health-related questions 24 hours a day, and ensures that its health plans offer extensive preventive care, such as coverage for yearly health check-ups.

"We're seeing less claims on more serious illnesses," Tim Smith, an American Airlines spokesman, said of the program's impact.

But if Texans do nothing to improve their health, and their children mimic their poor eating habits and lack of exercise, the state is likely to have 19 million cases of the seven illnesses, with a treatment cost and economic impact of $332 billion a year by 2023, according to the Milken study.

On the other hand, the Milken study says weight control, combined with good nutrition, exercise, further reductions in smoking and more aggressive early disease detection could prevent 3.2 million chronic disease cases in Texas, thus producing $90.2 billion in economic benefit in 2023.

The Milken study was partly funded by the Pharmaceutical Research and Manufacturers of America, the drug industry trade group.