Background: Urbanization and rapid technological development have altered dietary behaviors and physical activity patterns, contributing to ongoing nutrition transitions and potential urban–rural disparities in adult nutritional status in low- and middle-income countries, including Indonesia. Objective: This study examined urban–rural differences in nutritional status, dietary intake, and physical activity among adults in West Sumatra, Indonesia. Methods: A cross-sectional study was conducted among 416 adults aged 18–59 years, equally recruited from urban and rural areas with a balanced sex distribution. Nutritional status was assessed using body mass index (BMI) and waist circumference. Dietary intake was evaluated using a 24-hour dietary recall, and physical activity was measured using metabolic equivalent tasks (METs) derived from the Global Physical Activity Questionnaire. Group differences were analyzed using chi-square tests and Mann–Whitney U tests. Results: Waist circumference and the prevalence of abdominal obesity were significantly higher among urban than rural women (p = 0.001 and p = 0.018, respectively), and total protein intake was significantly higher among urban participants (p = 0.018). However, mean BMI, total energy intake, most macronutrient intakes, and physical activity levels did not differ significantly between urban and rural populations (all p > 0.05). Conclusion: This study provides evidence of an ongoing nutrition transition in West Sumatra, characterized by emerging urban–rural differences in abdominal obesity among women and dietary protein intake, while overall BMI, total dietary intake, and physical activity levels remain similar. These findings emphasize the need to include central obesity indicators in nutritional surveillance and to implement context-specific public health interventions addressing nutrition transition. © 2026 Sociedad espanola de dietetica. All rights reserved.