When I was 250 (at 5’9”) and planning on competing, I was at my least healthy ever. I was young but ended up with tachycardia, which I was fortunately able to reverse. My doctor was a quack who kept prescribing asthma medication because I couldn‘t breathe. When I asked him to check my heart, he just laughed and told me I was in peak condition. I finally insisted, and was at the cardiologist the nexr day. This happens every day in the bodybuilding world.