Clyde Anderson has a thick, raised scar, three centimetres wide, that runs down the centre of his chest where his ribcage was cut open.

In 2020, surgeons extracted veins from Anderson’s leg and grafted them to his heart in a quadruple bypass. His original coronary arteries had become so clogged with fat that he had had a heart attack.

“I was truck-driving and eating when I could, eating fast food,” says Anderson, 54. At the time, he weighed around 19 stone (120kg). “Then my health checked up on me.”

But by many accounts, Anderson, who has since sworn off fried food and is several stone lighter, is one of the luckier residents of Holmes County in rural Mississippi.

“I have classmates who died from diabetes and heart attacks in their 30s,” says Roneda Lowe, 42, another local.

This is the reality of living in the fattest place in America.