Not surprising to me.

Rural people have overwhelmingly larger waist to height ratios than urban populations.

Grew up in one of the states studied in an exurb, lots of family on farms. Everyone I know more than 30 min from a sizable downtown is as fat as can be.

https://www.cdc.gov/nccdphp/dnpao/division-information/media...

https://www.npr.org/sections/goatsandsoda/2019/05/08/7213737...

What is surprising are the diabetes stats - there’s actually a case to be made that you’re more likely to be diabetic in an urban area. Maybe some combination of stress/sleep/drinking/smoking?