Shrinking appetites: Will GLP-1 adoption in high-income countries accelerate Big Food’s push into low- and middle-income countries?

BACKGROUND: Glucagon-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. CONCLUSION: Policymakers 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.