I'm certainly no expert on otos and have had terrible luck with them. I have lost 7 or 8 since January and don't plan to buy any more. I do know that since they are wild caught like Inchworm mentioned, you should wait till the LFS has had them a couple weeks so that the unhealthy ones will die off and what you get are the ones that are in the best shape. Also, I read (don't remember where and someone correct me if this is wrong) that they have a bacteria in their stomachs that helps digest the algae they eat. Apparently, if they are deprived of food for extended periods, they start to consume that bacteria for food. As I said, I'm not certain this is true or not. I did a Google search and found a couple things that mention the same thing but no actual fish profiles that say anything about it. Pure and simple they are delicate and prone to sudden deaths.
Edit: As Inchworm said, the fat belly is generally a good sign. I have heard the expression that "a fat oto is a healthy oto" more than once.