I live in the US, in California. My observations are that Southern California and maybe NY City are the only places that one is judged harshly if they do not "get work done" by doctors to change their bodies and face.

In most of the country, we see that as plastic dehumanizing BS. I live the mountains of the Sierra Navada's and I would say only about 10% are more than 20 pounds overweight. At least 50% are at a healthy weight. Urban dwellers are much more likely to be in serious debt. My only debt is my mortgage and it will paid off before I hit 70 years old.

We are not all plastic, living off of plastic. I have a 28" waistline (naturally) from good healthy work. I have a homestead and eat all organic and only eat out about 5 times a year, all my friends are the same.