Although Rich’s autopsy was inconclusive, there are a handful of things which are believed to have contributed to his sudden death. He collapsed while getting a haircut from his girlfriend, who performed CPR until the paramedics arrived at his home. There was speculation about a possible drug overdose after a white substance with a credit card was found nearby, along with his girlfriend’s own claim that Rich had struggled with opiate addiction.

Rich was put into a medically induced coma to try and stop his brain from swelling, but two weeks later, he died. His autopsy did reveal evidence of heart disease and that his heart and liver were twice the normal size, which is a side effect of long term steroid use. However, there was never an official cause of death put on the record.

In Rich’s interview with Daniel Tosh, he was honest about what his weight meant for his health, even if his weight was brought on by muscle instead of fat.

"My body fights me the whole way, my body does not want to be 300 pounds," Rich said. "Whether it’s muscle or fat, the heart doesn't know the difference … I definitely suggest people to not be big bodybuilders." He added that getting to his level of physique is "physically counterproductive."