They die much younger than otherwise fit & healthy people. The extra layers of fat mean that their heart has to pump much harder than for a healthy person, essentially putting fat people at a much higher risk of several heart diseases as the heart muscle gets weaker much faster with age.
The extra layers of fat also have other negative side effects like putting more strain on blood vessels and increasing the risk of blood clots, strokes and many other secondary issues. There are literally so many health issues directly linked to obesity that I can't understand why so many people in developed countries care so little about their weight.
It's particularly surprising because physical exercise doesn't cost anything and healthy food is extremely cheap if one can be bothered to learn how to cook. I've been raised on extremely cheap but healthy food. We would buy 10kg of rice which was cheaper than a single Big Mac menu and cheap vegetables which could be cooked up with rice and a sauce. People claim that eating healthy is difficult when you're not rich but I can say from 1st hand experience that this is an ignorant statement to make. Buying prime grass fed beef is expensive, but that is not healthy. Eating beef or lamb 5x a week is actually unhealthy. Vegetables and rice is cheap everywhere.