Have to "weigh in" on this. Been based on NC since '82. Sure, lots of fatties here. But no more than other environs with similar socio-economic dynamics. Inner-cities and rural settings across the USA all have similar dietary and lifestyle patterns. Sure, the South is known as the "stroke belt" with regional eats featuring an abundance of fried foods high on fats and carbs. Pork tops the food pyramid, still. The old adage rings true: "No part of the hog goes to waste. We use every part except the squeal." Even veggies are traditionally prepared overcooked with a hunk of piggy in the mix. Living "high on the hog" is still a thing.
What I have noticed, though, is NC has been inundated with transplants, mostly from the northeast and midwest, as well as FL "half backs." These folks are hardly the epitome of health, to a "large" extent. And they typically bring an appetite for traditional Southern fare, as well as their own regional specialties loaded with fat, carbs, sodium, etc.
What's the difference between a "Yankee" and a "Damn Yankee"? Yankees visit and then go back home. Damn Yankees stay. And then proceed to complain about their new state and try to make NC like the place they moved from. "That's not the way we do it up north.," they'll say. "Yeah. We know. So why are you here?" is a popular retort. LOL. )