Huntington, WV is city of 50K. Not the middle of nowhere....

My in-laws are from West Virginia. They have poor eating habits as a cultural/regional thing, not because of lack of access to fresh foods. There's a great supermarket right down the road from their house, but they still choose to cook all their vegetables with either lard or bacon.

And yes, they are car happy. I could not believe it when they DROVE to church, which was literally 4 doors down!