Prevalence of Overweight among the Middle Eastern Adult Population in the United States.

AuthorAmin, Neveen Shafeek
PositionArticle 2

The striking increase in the prevalence of being overweight and/or obese continues to be the leading public health concern in the United States. In 2017-2018, the prevalence of overweight and obese adults rose dramatically in the U.S. and was estimated at 73.6 percent, an increase of 2.4 percent since 2015-2016. Seventy-seven point one percent of men and 69.4 percent of women were either overweight or obese. (1) The overall prevalence of obesity was highest among non-Hispanic black adults as compared to Hispanic, non-Hispanic white, and non-Hispanic Asian adults. (2) The immigrant population in the U.S. has increased in the past five decades. In 2019, there were 44.9 million immigrants in the U.S., comprising 13.7 percent of the U.S. population. (3) It is projected that by 2050, almost one in five U.S. residents will be an immigrant. (4) Given such a rapid immigrant population increase, it is crucial to study their health status. Research has shown that, in general, immigrants have better health profiles compared to their U.S.-born counterparts when they arrive in the U.S., a phenomenon known as "healthy immigrant effect." Yet, the longer they stay in the U.S., the more their health deteriorates. (5)

Immigrants in the U.S. are disproportionately affected by being overweight and obese among other chronic conditions. Research on immigrant health indicates a high prevalence of overweight and obese immigrants in the U.S. (6) Previous studies have shown that Hispanic immigrants have higher odds of reporting obesity compared to non-Hispanic whites and Blacks. (7) On the contrary, Asian adult immigrants reported the lowest rate of obesity compared to non-Hispanic white, Black, and Hispanic adults. (8) Additionally, prior research has shown that being overweight and/or obese is associated with many health conditions such as hypertension, heart diseases, and type 2 diabetes. (9) Past work has also shown that the prevalence of being overweight and/or obese is positively associated with time in the U.S. (10)

Sex has been reported to have a strong relationship with being overweight and obese among immigrants. Among Hispanic populations in the U.S., the prevalence of being overweight and obese were higher among men than women, (11) and higher than the national average, 77.9 percent of Hispanic men and 76.2 percent of Hispanic women were overweight or obese. (12) Among non-Hispanic Asians, overweight rates were higher among men (42.4 percent) compared to women (34.4 percent). (13) Contrarily, a more recent study found no significant sex differences among non-Hispanic Asian and Hispanic adults with regard to the prevalence of obesity. (14) However, these studies have only focused on Hispanics, Blacks, and Asians.

Although one of the rapidly growing immigrant groups in the U.S., there is limited research about Middle Eastern (ME) immigrants (15) in the public health literature. Middle Eastern (ME) immigrants come from a rich and diverse cultural heritage including different ethnicities, religions, education levels, socioeconomic status, and languages. The relatively few studies that examine health outcomes of ME immigrants in the U.S. provided mixed results. While some studies found that ME immigrants are healthier than U.S.-born, non-Hispanic whites, (16) other studies found the prevalence of obesity among ME immigrants does not differ significantly from that of non-Hispanic whites. (17) Community-based studies found that they are at risk of a high prevalence of obesity/BMI. (18) The one study that compared the prevalence of being overweight and obese among ME men and women utilized a community based sample of ME immigrants in Michigan. (19) This study found that ME women had higher prevalence of being overweight and obese compared to ME men.

From the research reviewed above, it can be seen that there is a need for empirical studies that investigate the prevalence of being overweight/obese among immigrants in the U.S. Therefore, using eighteen years of nationally representative data from the National Health

Interview Surveys, the current study extends previous literature on immigrant health by examining the estimated prevalence of being overweight among Middle Eastern (ME) immigrant men and women in the U.S. Moreover, this study examines the factors that are associated with being overweight in this population.

Data and Methods

This study analyzes pooled data from the 2000-2017 National Health Interview Surveys (NHIS). The NHIS is a multipurpose health survey conducted annually since 1957 by the National Center for Health Statistics (NCHS) and Centers for Disease Control and Prevention, and is administered by the U.S. Census Bureau. The NHIS is a multi-stage, stratified, cluster sample that is designed to manage information on the non-institutionalized, civilian population in the U.S. (20) Using face-to-face interviews, data on health, health care services, and behaviors are collected for all individuals of sample households. The NHIS data are available as public domain. Detailed information about the NHIS can be found on the CDC_NHIS website ( To improve the reliability of statistical estimates, eighteen years of data was pooled. The analyses for this paper mainly draw data from the sample adult files of individuals eighteen years and older. These files were linked with corresponding person, household, and family files when necessary. The analyses were limited to non-Hispanic, Middle Eastern immigrants (N=1622).

Middle Eastern Immigrants

Foreign birth was considered a proxy for immigrant status. (21) In 2000, the NHIS included a question about global region of birth. This, in turn, helps to distinguish the ME immigrant population. Respondents were asked to choose their region of birth from the following categories: United States, Mexico/Central America/Caribbean Islands, South America, Europe, Russia, Africa, Middle East, Indian subcontinent, Asia, Southeast Asia and elsewhere, and unknown. They were also asked whether or not they considered themselves Hispanics/Latinos. Middle Eastern immigrants are individuals born in the Middle East region and are non-Hispanic; all other groups are dropped from the analysis. (22)


Using the National Institute of Health cut offs, overweight and obesity are combined into one category and defined as a body mass index (BMI; weight in kilograms divided by height in meters squared) of 25 kg/m (2) or more among adults. Demographic variables include age, recoded into four different age groups (18-24, 25-44, 45-64, and 65-85), marital status (married, coded 1), and sex (female, coded 1). Socioeconomic variables include level of education ([less than or equal to] high school or some college, coded 0 and college graduate or advanced degree, coded 1), employment status (employed, coded 1), and homeownership (own their home, coded 1 and rent or other arrangements, coded 0). Healthcare utilization was measured by two questions, whether participants have health insurance (yes, coded 1) and have seen or talked to a doctor in the past twelve months (yes, coded 1).

General self-rated health was measured with the question: "Would you rate your health as excellent, very good, good, fair, or poor?" Similar to prior research, (23) responses were recoded as excellent, very good, or good = 0, and fair or poor = 1. Respondents with any activity limitations were coded as 1. Respondents were also asked whether they were diagnosed with diabetes (yes = 1), hypertension (yes = 1), and heart disease (yes = 1) and whether they smoke (yes= 1). To measure...

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