Although, rural Americans are also used to driving longer distances than rural Germans. I would venture that a 30-40 minute trip is not thought of as significant, especially if only done 1-2 times per week.
Rural grocery shopping (real food, not snacks), is typically done at Walmart or a smaller grocery brand or independent. For quick errands, DG does get a lot of it. You're starting to see grocery store logistics push in to what were traditionally gas-and-convenience-store corners, including Aldi, so the commutes for groceries are getting shorter.
It will be interesting to see what happens in the US with the price war over GLP-1 weight loss pills. Unlike Ozempic injections, they're going to penetrate into low income and rural households.
what percentage of people on Ozempic etc. are poor enough that they would be priced out by healthier food?
You can tell Germany cares for its population via food regulation and from what's offered; whereas, it's a toxic trash heap in America solved with drugs or paying a higher premium for healthier items. The healthier items in America should be a baseline instead of pricing out people. Feels like Americans are paying for a premium upfront or downstream via pharmaceutical/healthcare solutions.