Misconception. Fat people get their heart attacks and die in their 50s and 60s, which is actually quite optimal from an actuarial standpoint because they've paid out in taxes for most of their functional lives.

Real spending comes from frail elderly care as we keep these patients alive and they bounce back from the hospital in their 80s and 90s, go to nursing homes because their kids can't take care of them, slowly develop dementia and come back with recurrent pneumonias, UTIs etc.

In most other countries common sense prevails and these people would be made DNR/DNI and pass comfortably and peacefully but here the guilty out of state son who hasn't seen mom in 3 years will tell us "she's a fighter" and the patient will end up in the ICU for 2 months of suffering and being kept alive.