ArticleGlobalization and health2026
Shrinking appetites: Will GLP-1 adoption in high-income countries accelerate Big Food's push into low- and middle-income countries?
Article in Globalization and health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundGlucagon-like peptide-1 (GLP-1) based medicines (for example Ozempic, Wegovy, Zepbound) are moving rapidly from specialist care to mass adoption in high-income countries, with measurable effects on food purchases and eating patterns. Early retail and household panel data from the United States indicate that households with a GLP-1 user reduce total grocery spending by about 5% within six months, with larger declines among higher-income households and even more marked reductions in snacks and other energy-dense items. Major manufacturers are already deploying "GLP-1-responsive" strategies such as reformulation, smaller portion-size packaging, and "GLP-1-friendly" branding. MAIN BODY: We argue that if demand for energy-dense, ultra-processed products softens further in high-income markets, transnational food and beverage firms may hedge by redirecting and intensifying marketing pressure and portfolio growth towards some low- and middle-income countries (LMICs), where regulatory frameworks often remain weaker and GLP-1 access remains uneven. This could add to the already rising burden of diet-related non-communicable diseases linked to ultra-processed foods and beverages in LMICs. The risk is sharpened by limited and inequitable access to GLP-1 therapies in these settings, even though most people living with overweight and obesity are projected to reside in LMICs by 2035. We outline plausible pathways for an LMIC GLP-1 "spillover effect", including intensified corporate political activity, more aggressive marketing, accelerated modern retail expansion; and more aggressive use of price promotions, pack size engineering, and premium "healthier for you" ultra-processed products.
conclusionPolicymakers and global health actors should treat GLP-1 induced shifts in high income countries as an early warning signal. Precautionary, equity focused policies are needed to prevent potential GLP-1-related demand shift from translating into heightened commercial determinants of health in LMICs. Policy safeguards should include comprehensive restrictions on unhealthy food marketing including digital marketing; fiscally effective excise taxes on sugar sweetened beverages and other ultra-processed products; stronger management of conflicts of interest in food policy; and improved monitoring of retail food environments and corporate practices.
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