When asked how she felt about winning the crown, she said, "Ask me after I've had a pizza."
Fakih nearly fell while finishing her walk in a long, strapless gown because of the length of its train, but she made it without a spill and went on to win.
During the interview portion, Fakih was asked whether she thought birth control should be paid for by health insurance, and she said she believed it should because it's costly.
"I believe that birth control is just like every other medication even though it's a controlled substance," Fakih said.
Fakih replaces Miss USA 2009 Kristen Dalton and won a spot representing the United States in the 2010 Miss Universe pageant. She also gets a one-year lease in a New York apartment with living expenses, an undisclosed salary, and various health, professional and beauty services.
Miss Oklahoma USA Morgan Elizabeth Woolard was named first runner-up after handling a question about Arizona's new immigration law. Woolard said she supports the law, which requires police enforcing another law to verify a person's immigration status if there's "reasonable suspicion" that the person is in the country illegally.
She said she's against illegal immigration but is also against racial profiling.
"I'm a huge believer in states' rights. I think that's what's so wonderful about America. So I think it's perfectly fine for Arizona to create that law."
"The Office" actor Oscar Nunez was booed as he asked the question and asked the audience to wait until he finished the question before they reacted.
Miss Virginia USA Samantha Evelyn Casey was the second runner-up, Miss Colorado USA Jessica Hartman was third runner-up, and Miss Maine USA Katherine Ashley Whittier was the fourth runner-up.
Most of the field of contestants from all 50 states and the District of Columbia were eliminated just after the pageant began and the entire group danced onstage to "TiK ToK" by Ke$ha.
A panel of eight judges, including NBA star Carmelo Anthony and Treasure Island casino-hotel owner Phil Ruffin, were judging the girls throughout the night.
After 15 contestants strutted in swimsuits, five were eliminated. Another five were eliminated after the evening gown competition.
Miss Nebraska USA Belinda Renee Wright won the Miss Congeniality award, roughly one week after her father was killed in a farm accident. Miss Alabama USA Audrey Moore won Miss Photogenic after an online fan vote.
The pageant aired live to East Coast viewers on NBC. The network owns the pageant in a joint venture with Donald Trump.
The competition, which is not affiliated with the Miss America pageant, was hosted by celebrity chef Curtis Stone and NBC correspondent Natalie Morales.