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I'd think that you stay the way you were when embraced, excluding vicissitude, but I'm sure someone more versed in VTM lore will have a better answer.
So. VTM lore. You 100% stay the way you were when you were embraced. This means if you have a blood clot in your brain making you entirely paralyzed? You are a quadriplegic vampire. Yes. It is possible to be a vampire who is entirely incapable of moving who has not been staked. It's a special hell you can subject the crippled to, depending on what story teller you're dealing with. For the record, that's one -hell- of a jackass move, which would likely cost you rather a lot of humanity.
This means that corpulent vampires do in fact exist, however, it's worth noting that kindred tend to sire based on what's considered beautiful by them. Rome tended to view fat as beautiful, meaning, if you wanted morbidly obese vampires, you want ancient vampires, old enough to have existed back before Caesar. There are other cultures that have viewed fat as beautiful, and people have had their varying interests throughout history, so, yes, fat vampires do exist.
Now let's talk about how fat functions in regards to a vampire. All the downsides of having fat? They're still there. All the upsides, the resource maintenance, the ability to live through not eating for a while, the possibility of gaining muscles under the fat by simply remaining active in spite of your weight? All those options are missing in action. So a fat vampire tends to have all the weaknesses of a fat person, with none of the benefits, which makes them -generally- less impressive vampires.
Now as for in lore, Vampires tend to be meant to be something of a set of sex objects in recent pop culture, partially due to the fact that they're meant to be seductive sinners with a tendency of acting somewhat intimately to get the one thing they need and desire above all else. As such, corpulent vampires are SOMEWHAT rare due simply to that popularity. That said, they do appear in realist portrayals (Either as entities who were favored servants of the vampire, or simply due to a high enough intellect / interest gained to be -worth- promoting to the role), as well as for parodies.
Excellent answers, thank you. I didn't know about the paralysis part.
I do agree about the sex object bias making fat vampires rarer, as well.
https://www.youtube.com/watch?v=fbEEeoo1QkA
Right, but the sexiness part still kind of detracts from the more realistic... dare I say... the higher probability of a recently embraced vampire looking more like... the people you see on a Cops rerun.
The woman next to the piano was more... glam-fat.
I knew I forgot something. I saw that in the theaters when it first came out, but haven't watched it since.
Additionally, before I forget, the Macellarius in Vampire: Requiem (A less popular continuation of Vampire the Masquerade) had blood powers that were based on being flesh eaters. They didn't actually....digest it though. It just became stored. As such, they were very much fat vampires, with a note that after just three days of being embraced, they would gain over a hundred pounds, up to 150, and that as the years went by, they would put on more and more pounds, to impossible levels. The Discipline in question is "Gustus"
https://whitewolf.fandom.com/wiki/Etrius
As StartComet1 says. The vampire Etrius is fat. That vampire looks like a role player of the 90s.
The issue is, you get lyposuction, absolutely. You then immediately start regenerating to the same shape and appearance you had just prior to getting lyposuction. This is something that's supernatural and highly varied in what precisely it considers not okay. You're right though, the internal organs don't exist, it's just that the problems that were experienced in those organs continue to exist.
The reason for this issue being canon are fairly divided in precise reason. VTM is a setting designed to be LARPed in. If you have severe asthma, or you can't get out of a wheelchair and walk around, or you need to walk with a cane, they don't want to make a setting that disavows all that. This is also true of fat people, they can't say there are no 'fat vampires' and be in a comfortable place given they want people to be able to play their game. Now, if it was just for RPing? Sure, say whatever you want, although the more variation you allow in character design without necessarily enforcing it, the happier people will generally be.
My friend had a character, who sported a beard and long hair before he was Embraced. Each evening he shaved his head and face clean xD
It looks like another task for Vissicitude Nightly Service™, a family tzimisce business with prices beyond competition !