Full-size and heavy-duty are overlapping descriptions, not opposing truck sizes. Heavy-duty pickups are generally full-size. The useful comparison is between a light-duty full-size pickup, commonly intended to balance passenger travel and hauling, and an HD pickup configured for more demanding carrying or towing work.
From the light-duty buyer's perspective, the question is whether the truck already meets the real workload or whether an HD configuration is necessary. Similar-looking cabs can sit above different chassis and running gear. A powerful light-duty engine does not turn that vehicle into an HD truck, and unused HD capability does not automatically make everyday ownership better.