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Women who are fat yet fit appear less likely to suffer a heart attack or die than those who are slender but slothful, University of Florida researchers report today in the Journal of the American Medical Association.

But don鈥檛 view the news as a reason to soothe a snack attack with fatty favorites or to pile on a second hefty portion at mealtime 鈥� it鈥檚 best to aim for trim and in shape, says cardiologist Timothy R. Wessel, M.D., an investigator at UF鈥檚 网红黑料 Science Center and the report鈥檚 lead author. Still, the study suggests body weight may not be as crucial as regularly pounding the pavement with a brisk walk, staking out a spot at the gym or simply doing household chores.

鈥淥ur study accepts the fact that obesity is a cardiovascular risk factor,鈥� Wessel said. 鈥淚t is and has been shown to be so in multiple studies. But what this study suggests is that simply modifying weight without modifying your physical fitness level is not addressing a perhaps more important risk condition for cardiovascular events; that is, poor physical fitness.鈥�

The researchers say their results clearly emphasize the need to assess an individual鈥檚 activity level as a routine part of the medical exam. A 12-item questionnaire used in the study to assess the women鈥檚 perceived level of fitness is a powerful tool that easily could be adopted by physicians to identify patients prone to future problems, said Carl J. Pepine, M.D., chief of cardiovascular medicine at UF鈥檚 College of Medicine and the paper鈥檚 senior author.

鈥淚t鈥檚 amazing that a simple 12-item questionnaire predicted adverse outcome as well as it did,鈥� Pepine said. 鈥淚 believe that the real implications from the project are that this may be a tool to incorporate into our routine evaluation of patients.鈥�

The findings come as experts note a staggering two-thirds of U.S. adults are overweight and more than a third are obese. Obesity heightens the risk of heart-related problems, in part because it is associated with the development of artery-clogging fat deposits and malfunctioning blood vessels. But the UF study is important because it shows that a patient鈥檚 own perceived physical activity level alone appears to predict heart disease risk, even after accounting for weight, traditional cardiovascular risk factors and body measurements, such as body mass index, waist circumference or waist-to-hip ratio, Pepine said.

鈥淭here鈥檚 no doubt that increasing levels of obesity are associated with many potential medical problems over time, not the least of which are cardiovascular disease, diabetes and hypertension. The latter conditions can lead to serious heart disease,鈥� he said. 鈥淏ut it seems from this research that at least women may be able to negate some of the adverse effects of obesity and being overweight by increasing their levels of fitness.鈥�

UF researchers studied about 900 middle-aged women who were enrolled in the National Heart, Lung and Blood Institute-sponsored Women鈥檚 Ischemia Syndrome Evaluation, or WISE.

All had symptoms suggestive of reduced blood flow to the heart. WISE seeks to define the prevalence, extent, severity and complexity of heart disease in women and also aims to find ways to better predict it.

About 41 percent of study participants were obese, defined as a body mass index greater than or equal to 30; all told, three-quarters were overweight. A little more than half had high blood pressure or high cholesterol. Two-thirds had no evidence of obstructed arteries on coronary angiograms.

The women completed a questionnaire that assessed measures of fitness, including whether they participated in light sports, could climb a flight of stairs, carry groceries up stairs or run a short distance. Results are designed to express the questionnaire findings in terms of the standard exercise treadmill test performance commonly used to gauge heart health.

鈥淚n the study we used the term physically fit not to describe trained Olympic athletes but to correspond to the day-to-day activities many of us do,鈥� Wessel said.

The UF researchers found that lower fitness levels were associated with a higher-than-expected rate of heart attack, stroke, hospitalization and death during follow-up. Overall, about half the study participants developed heart-related adverse events. Of those, about 28 percent of the women classified as obese yet fit experienced heart problems, just slightly more than the 24 percent of women who were lean and fit. In contrast, a startling 43 percent of those who were lean but unfit developed events, comparable to the 42 percent of those who were obese and unfit who also fared poorly.

鈥淭he suggestion is that it鈥檚 actually better to be in shape even if you are obese. If you were out of shape, being thin did not offer protection,鈥� Wessel said. 鈥淛ust being at a lower body mass index or some other measure of obesity is not as important as better fitness or having higher activity or exercise capacity.鈥�

However, many popular approaches to tackling obesity, such as diets, focus on weight loss alone and fail to stress efforts to improve physical fitness, he said.

鈥淚t鈥檚 alarming to see recent weight loss trends that involve following a diet plan and don鈥檛 emphasize changing physical activity or fitness at all,鈥� said Wessel, adding that the American Heart Association recommends women participate in at least 30 minutes of moderate exercise every day. 鈥淭oo many people just diet and don鈥檛 do more exercise.

鈥淭o practitioners we鈥檇 say that assessing a patient鈥檚 level of physical fitness or functional capacity should be at least as important as assessing their weight status, and that these simple self-reported questionnaires could be easily used as part of a cardiovascular risk stratification program,鈥� he added. 鈥淔or the general public, the bottom-line message is it鈥檚 not enough to just focus on weight without making the lifestyle modifications that increase physical fitness. Just being on the Atkins diet and losing 20 pounds does not mean you鈥檝e decreased your risk of a cardiovascular event.鈥�

In an accompanying editorial, Steven N. Blair, P.E.D., and Tim S. Church, M.D., M.P.H., Ph.D., of the Cooper Institute in Dallas, wrote that the findings 鈥減rovide a timely opportunity to examine an ongoing debate and offer a resolution.鈥�

鈥淚n essence, physical activity is the common denominator for the clinical treatment of low fitness and excess weight, making the 鈥榝itness vs. fatness鈥� debate largely academic,鈥� they wrote. 鈥淭hus, physicians, researchers, and policymakers should spend less energy debating the relative health importance of fitness and obesity and more time focusing on how to get sedentary individuals to become active.鈥�