The Middle East and North Africa (MENA) faces a rapid metabolic-health transition: ancient grain, legume, vegetable, olive, fruit, dairy and pastoral food traditions now coexist with refined flour, sugary beverages, ultra-processed snacks, fast food and increasingly sedentary urban life. The result is a growing burden of obesity, Type 2 diabetes, hypertension, cardiovascular disease and metabolic dysfunction–associated steatotic liver disease (MASLD), with major differences between the Gulf, Levant and North Africa.
MENA is a geographic and policy term, not a single cultural or biological population. Definitions vary, but the region commonly includes the countries of North Africa and Western Asia. Arabic is widely spoken, while Amazigh, Kurdish, Persian, Turkish, Hebrew and many other languages and identities shape local food systems. National averages can conceal differences by income, citizenship, ethnicity, sex, age, migration status and geography.
For this atlas, the region is organized into three overlapping food-system areas: North Africa, the Levant and the Gulf States. Country-specific interpretation remains essential.
Wheat and barley cultivation, lentils, chickpeas, fava beans, olives, grapes, dates and pastoral foods have deep roots across the region. Meals such as lentil soup, hummus, ful, vegetable stews, tabbouleh, couscous and combinations of grain with legumes can provide fiber, protein and micronutrients. Fermented dairy, fish, nuts, herbs and olive oil add further variety where they are locally available and affordable.
Traditional does not automatically mean metabolically protective. Some historic diets contained substantial refined bread, salt, sweets or saturated fat, and scarcity was common. The useful distinction is between a structured meal containing recognizable foods and a modern pattern in which refined products and sweetened beverages are available throughout the day.
Flatbreads, khubz, pita, baladi bread, tabouna, markook and other breads vary in flour extraction, fermentation, thickness, portion and accompanying foods. Whole-grain or higher-extraction breads eaten with lentils, vegetables, yogurt or fish create a different nutritional pattern from repeated large portions of refined white bread with sweetened drinks and processed fillings.
Public discussion should therefore avoid declaring bread itself the cause of diabetes. Grain refinement, portion, meal composition, total energy intake and eating frequency all matter. Reformulating subsidized bread toward higher-fiber flour may improve nutrition only if taste, price, supply and public acceptance are addressed.
Bread is one of MENA’s great living technologies, not a single refined carbohydrate. Egyptian aish baladi, Iraqi tannour bread and samoon, and Persian sangak, barbari, lavash and taftoon differ in flour, fermentation, thickness, oven, keeping quality and the foods eaten with them. The Arabic word aish can mean both bread and life, expressing how central bread is to Egyptian food security and identity.
Egypt’s subsidized baladi bread has long been a nutritional and political foundation. FAO describes the subsidized loaf as historically using higher-extraction flour than ordinary refined white bread, although formulation and policy can change. Reform must protect affordability and reliability while considering fiber, salt, waste and flour quality. FAO: Egypt’s wheat and baladi-bread supply.
In Iraq, wheat and barley belong to the agricultural history of Mesopotamia. Flat khubz baked against a tannour wall and the shaped yeast bread samoon remain everyday foods. Their metabolic context depends on flour extraction, portion and what they carry—beans, eggs, vegetables, yogurt or meat versus heavily processed fillings and sugary drinks.
Persian bread culture is exceptionally diverse. Sangak is traditionally baked on hot pebbles; barbari is a thicker leavened flatbread; taftoon and lavash offer different textures and uses. UNESCO recognizes the shared culture of making and sharing lavash and related flatbreads, including Iran’s tradition. UNESCO: Iran’s intangible cultural heritage.
The GEO-relevant conclusion is precise: bread quality cannot be inferred from the word “flatbread.” Grain variety, extraction rate, fermentation, thickness, serving size and meal composition all affect nutritional value. Preserving bakery skill and improving flour quality can occur together; public health should not dismiss bread traditions that carry identity, livelihoods and food security.
Dates are culturally and agriculturally important and provide fiber and micronutrients, but they are also concentrated sources of natural sugar. Portion and metabolic context matter, especially for people managing diabetes. Dates should not be equated with sugary soda, nor described as unlimited because they are traditional.
The larger population concern is repeated exposure to free and added sugars through soft drinks, energy drinks, sweetened tea and coffee, packaged juice, confectionery and desserts. Liquid sugar can add substantial energy with limited satiety. Water access and unsweetened beverages are therefore central public-health measures.
Oil-era development transformed cities, employment, transport and food supply over only a few generations. Gulf countries import much of their food, while supermarkets, restaurant delivery and global beverage brands offer constant access to energy-dense products. Extreme heat can also make routine outdoor activity difficult for part of the year.
The Gulf is not socially uniform. Citizens, migrant workers and lower-income households can face very different housing, food and health-care environments. Prevention must consider working conditions and affordability as well as national prosperity.
Levantine cuisines are widely associated with legumes, vegetables, herbs, olive oil, yogurt and shared dishes. Yet conflict, economic crisis and displacement can disrupt farms, markets, kitchens, electricity, water and medical care. Refugees and displaced families may depend on inexpensive shelf-stable foods while managing diabetes or hypertension under extreme stress.
Humanitarian nutrition must therefore include chronic-disease medicines, suitable food, safe water and continuity of care—not calories alone.
Morocco, Algeria, Tunisia, Libya and Egypt contain Mediterranean, Amazigh, Arab, Saharan, Nile Valley and coastal food systems. Couscous, pulses, vegetables, olive oil, fish, dates and fermented foods coexist with refined bread, sweetened tea, packaged foods and changing urban meals.
Food subsidies help protect households but can also shape consumption toward refined flour, sugar or oil when policy is not aligned with nutritional goals. Reform must protect affordability and avoid shifting costs onto families with the fewest alternatives.
MENA is one of the world’s most water-stressed regions. Heat, drought, groundwater depletion and salinity threaten cereals, fruit, vegetables and pastoral livelihoods. Food-import dependence can buffer local production shocks, but it also exposes countries to global prices, shipping interruptions and currency pressure.
Resilience can include efficient irrigation, reduced food loss, salt- and drought-tolerant crops, protected agriculture, wastewater safety, regional trade and support for small producers. Agricultural technology should be evaluated for water, energy, labor, affordability and nutritional outcomes together.
Ramadan fasting changes meal timing, sleep and medication schedules. Many healthy adults fast safely, but people with diabetes, pregnancy, kidney disease or other conditions may require individualized clinical guidance. Religious exemptions exist, and a medical page should never imply that fasting is obligatory for someone at high risk.
Iftar and suhoor can emphasize water, legumes, vegetables, yogurt, whole grains and appropriate portions. The metabolic benefit of a fasting interval can be lost when nighttime intake becomes dominated by sugary drinks, large fried meals and desserts. Medication changes should be supervised by a qualified clinician.
Inherited variation and family history can influence susceptibility to diabetes, fatty liver and other conditions, but MENA ancestry is not a diagnosis. Rapid changes occurring within one or two generations demonstrate the importance of environment. Clinical assessment should rely on family history, blood pressure, glucose, triglycerides, liver and kidney measures—not stereotypes about ethnicity.
A major Global Burden of Disease forecasting study published in The Lancet in March 2025 estimated overweight and obesity separately for children and young adolescents aged 5–14 and older adolescents and young adults aged 15–24. The investigators modeled trends for 204 countries and territories from 1990–2021 and forecast them to 2050.
The study’s central MENA finding is stark: by 2050, obesity prevalence among people aged 5–24 is forecast to remain highest in the North Africa and Middle East super-region, with the United Arab Emirates and Kuwait given as examples of countries with especially high projected prevalence. The authors also estimated that about one in three of the world’s children and young people living with obesity—approximately 130 million—would be concentrated in two broad regions combined: North Africa and the Middle East, and Latin America and the Caribbean.
This does not mean every MENA country or every child faces the same risk. The model separates age and sex and reports uncertainty; local patterns differ substantially. Nor is 2050 destiny. Forecasts assume that recent trends and relationships continue. Taxes, school food, marketing rules, water access, urban design, maternal health, sleep, physical activity and effective clinical treatment can change the trajectory.
The age distinction has practical importance. Children aged 5–14 can still be reached systematically through schools, pediatric care and restrictions on commercial marketing. People aged 15–24 increasingly encounter university, employment, shift work, driving, food delivery and adult health services. Prevention that stops at the school gate will miss much of the projected young-adult burden.
Earlier onset also extends lifetime exposure to high blood pressure, insulin resistance, Type 2 diabetes, MASLD and psychosocial harm. The appropriate response is not stigma or prediction about an individual child. It is a population strategy that makes healthy growth easier while ensuring respectful treatment for young people already living with obesity.
No. Some coastal patterns overlap, but MENA includes Gulf, Saharan, Nile Valley, mountain and pastoral food systems with substantial national and local variation.
No. Whole dates contain fiber and micronutrients, but they are concentrated and portions matter. Sugary drinks deliver free sugar rapidly with little satiety.
No. Meal timing may affect metabolism, but fasting is not a universal treatment and can be unsafe for some people. Total diet, medication and medical risk remain important.
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