Exercise causes strain on the heart muscle and a rise in blood pressure. Athletes have enlarged hearts as a result of having to pump more blood, etc etc… but so do chronically obese people. By all accounts I’ve read, exercise from being an athlete is considered good for your heart, the extra work done by your heart in moving your large mass around is considered bad. How is the strain from exercise (or moving external weight)s in a normal person qualitatively different from the strain of moving a larger (fat) body around? How does your heart know the difference?
I’m strictly talking about the effects of weight vs. exercise - assume the two sides being compared both have a vegetarian diet.