SECTION 10 522 Middle East and North Africa


American Institute (AAI), have long advocated for a MENA categorization with a geographic designation in the US Census. Te category would have racial and ethnic options to account for diversity within the Arab commu- nity; it would also help identify people from these regions who are not of Arab heritage.


Refer to the section opener on pages 515 through 519 for more information about the Middle East and North Africa region’s countries and cultures.


Overweight and Obesity Limited research suggests high rates of overweight and obesity in Arab Americans. In a study of Arab Americans in Dearborn, Michigan, 34% of participants had obesity, com- pared with 26% of the US population at that time. Among the Arab Americans in this study, prevalence of obesity increased with age.13


Another study reported that 29% of


Arab American men and 37% of Arab American women in Michigan were classified as obese (BMI ≥30), and more than 50% of these adults had central obesity, defined as having a waist-to-hip measurement of 0.9 or higher for men and 0.85 or higher for women.14


A 2006 study found that 51% of


Arab American adults were overweight compared to 58% of non-Hispanic non-Arab Whites.15 Obesity can be a strong predictor of diabetes and other


Common Health Concerns Few studies have assessed the health needs and risks of Arab Americans. Existing public health data are mostly subjective or anecdotal and rely heavily on studies conducted in Michi- gan or California, where many people of Arab descent reside. Much of the available research on health issues among those with Arab heritage does not include more recent immi- grants, including refugees. Arabs living in America descend from different countries with varying dominating social and cultural attributes and, as a result, varying health outcomes. Poor psychological health and mental well-being related to stress, coping, or trauma are other drivers of nutrition- related diseases, including chronic disease profiles, as well as disordered eating.12 Historically, Arabs living in the US (which includes people of Arab heritage from Europe, the Middle East, or North Africa) have been pooled collectively within the White category for population and public health–related data collection. Without a racial or ethnic identifier, classify- ing those with Arab heritage as White restricts researchers’ ability to identify them in population-based studies and to use national data to understand health outcomes and dispar- ities.12


A federally recognized and separate specified racial or


ethnic identifier for Arab Americans would help researchers assess the health care needs of this growing minority com- munity. While the environmental and behavioral conditions that Arab Americans encounter are similar to those of the general US population, customs and cultural norms differ and may also influence health risks and outcomes.


noncommunicable diseases. A more recent study found that Arab Americans with comorbidities (hypertension, diabetes, or hyperlipidemia) were more likely to be obese. Teir odds of obesity were three times higher if the individual had hyper- tension, 2.5 times higher if they had diabetes, and 2.2 times higher if they were diagnosed with hyperlipidemia. Age also seemed to be a determining factor. Older adults had a higher prevalence of obesity than individuals who were younger.16


Diabetes Prevalence rates of prediabetes and diabetes among Arab Americans has been estimated at 18% and 23%, respectively; prevalence is associated with obesity, physical inactivity, and lack of acculturation.15,17,18


A study addressing the epidemiol-


ogy of diabetes in an Arab American community in Dear- born, Michigan, reported that diabetes prevalence was 18% (41% of the participants aged 20 to 75 years had abnormal glucose tolerance). Prevalence of abnormal glucose tolerance was greater than 70% in individuals older than 60 years, with diabetes reported in 36% of men and 54% of women in this age group.17 A few studies showed that Arab Americans may not


have access to suitable educational tools and literature to help with diabetes care and management and to understand the risks associated with the disease.19,20


Among the earliest


intervention studies designed for Arab Americans was the Diabetes Prevention Program (DPP) in Michigan. Tis group lifestyle intervention was implemented to inspire weight loss and recognition of diabetes risk factors; the intervention was considered linguistically and culturally


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