Assents, dissents, and elaborations -- well, actually no assents -- to these two earlier comments that I have not noticed the American obesity epidemic as much as I expected, after a few years away.

"You need to get out more."
A note representative of many I received:

"You are in Washington.  Too many urbanites who buck the trend.  Spend a week off the coast - In Cincinnati, Columbus, St. Louis especially in the suburbs and you will see it."

Ripple Effects:

"Your comment about not seeing as many obese Americans as you expected to has prompted me to write. I teach product design in the college of engineering at [a major public university in the Midwest], and am currently working on a project to help the hospital technicians who do X rays, sonograms, CT scans, etc. It turns out that many of these folks suffer quite serious injuries at work, and by far the major cause of these injuries is the obese patients they deal with on a daily basis.

"It appears that most of these technicians are women who are often required to move patients who outweigh them by several hundred pounds. In fact, one of the techs we interviewed in our study pointed out that when she performs vaginal sonograms on very large women, each of the patient's legs often weighs more than she does. I've often read articles about the growing obesity problem in the US, but I've never come across anything concerning this large and growing problem, if you'll pardon the pun. 

"I find myself wondering, when I read about the growing cost of obesity in the US health system, if anyone is looking at the cost of injuries to the people who are responsible for treating these folks?"

More refined view of the regional difference:

"My personal, unscientific evaluation of obesity is that it's lower in big cities than small.  I live in Chicago, but have friends and family throughout the Midwest.  My impression is that I see more "volume abundant" people in the smaller and rural towns.  A little Googling gave that a bit of support, but it is related to property values:  titled "Zip Codes And Property Values Predict Obesity Rates."  I don't know where you were making your observations, but that may be a big contributor.

"As I was writing this, I began to think about the process of going from the observation to the stated impression.  The study above was based on phone interviews taken only in King County, Washington (Seattle area) and extrapolated across the US.  That's a significant extrapolation, but all of us seem to be making a similar extrapolation. The difference is we're not even starting with randomized data.  If the source observations are limited to certain areas (rural IL, WI, MN, or SD vs. DC, Disney World, or NYC), then the perceived impression of obesity will likewise biased...

"I think the overall point is not so much the observations, but the expectations.  From news stories about US obesity, I quickly imagine 300 million Augustus Gloop's waddling through the streets.  Reality is much more nuanced than a headline grabbing story.  A couple percentage point higher rates of obesity in the US vs. wherever else is an important topic.  But, those 'couple percentage points' are hard to observe on an individual basis.

"Hell, I wear loose shirts and stretchy pants for a reason. :-)"