Objectives The nutrition and physical activity transitions, characterized by increased consumption of high energy density foods and more sedentary lifestyles, are associated with increased obesity and hypertension in Ecuador. These transitions have been characterized primarily in urban areas, which may neglect variation in specific rural areas of Ecuador. Therefore we examined the extent of the differences in dietary and activity patterns, obesity prevalence, and blood pressure (BP) in urban and rural‐dwelling women in the Ecuadorian central highlands. Methods Urban‐dwelling women (UW, n = 198, mean age = 44 years) from three areas of a city of 250,000 residents and rural women (RW; n = 202, mean age = 47 years) from three remote communities in the same province (Chimborazo) were randomly selected and surveyed for dietary and activity practices, BP, and anthropometrics. Results Ninety percent of UW reported obtaining their food primarily from markets while 65% of RW women obtained their food primarily from their own cultivation. Cookies, cakes, candies, ice cream, and French fries were consumed more frequently by UW. RW reported lower consumption of beef, poultry, and chicken, as well as fruits, milk, and white rice. UW compared to RW women spent less time walking and in strenuous work activities. Obesity (BMI > 30 kg/m2) (UW = 18.7% vs RW = 9.2%) and hypertension (UW = 15.7%, RW= 3.0%) were more common in UW. Average systolic and diastolic BP was significantly higher in UW. Conclusions The nutrition and physical activity transitions appear more evident in urban‐ compared to rural‐dwelling women, and are associated with more obesity and higher BP.