The metabolic syndrome (MetS), a constellation of cardiovascular risk factors, is a growing health challenge worldwide. Most studies on MetS epidemiology are from developed countries. The Middle East is lagging behind in understanding the epidemiology of MetS and its risk factors in the region. This is partly owing to a scarcity of high-quality, nationally representative studies. In a series of recent national surveys, we have studied the epidemiology of MetS and its risk factors in Iran. We review the current situation in the region and highlight current gaps of knowledge and epidemiological concepts that need to be taken into account when doing population-level health programming. We explore the results of our national surveys as successful examples along this path.