Are big retail chains driving global obesity? Study confirms alarming link

By Dr. Sanchari Sinha Dutta, Ph.D.Reviewed by Benedette Cuffari, M.Sc.Mar 9 2025

As large retail chains dominate global food markets, unhealthy eating soars—highlighting an urgent need to reshape food environments to combat rising obesity rates.

Study: Global food retail environments are increasingly dominated by large chains and linked to the rising prevalence of obesity. Image Credit: George Rudy / Shutterstock.com

In a recent study published in Nature Food, researchers assess the impact of the retail food environment on global health.

An overview of the global food landscape

Over the past 50 years, global food systems have radically transformed from independent and traditional food sources to systems that are often urbanized, industrialized, digitalized, and run by large retail conglomerates. These changes have increased the availability and affordability of many foods; however, modern global food systems are associated with numerous challenges, including inequitable access to nutritious foods and increased consumption of highly processed products.

Compared to traditional foods like grains, fruits, and vegetables, highly processed packaged foods are often high in energy while lacking essential nutrients. Consuming these foods increases the risk of numerous non-communicable diseases (NCDs), the most common of which include obesity, type 2 diabetes, and cardiovascular disease.

Diet-related decisions can be largely influenced by the type of retail food environment, which encompasses supermarkets, convenience stores, vending machines, cafes, and restaurants. Multinational food chains, for example, often offer affordable foods that are highly processed and unhealthy. Therefore, when these retailers are the only source of food in low- and middle-income regions, they inevitably contribute to NCD-related morbidity and mortality in these populations.  

To date, few studies have compared differences in the density of retail food systems within and between countries. Thus, it is imperative to better understand current and historical trends in the global food retail landscape and how these differences in food systems impact the prevalence of NCDs.

Study findings

The researchers of the current study measured changes in physical and digital retail food environment indicators across 97 and 23 different countries, respectively, from 2009 to 2023 and 2013 to 2023.

Between 2009 and 2023, the density of chain outlets increased from 2.63 to 3.25 for every 10,000 individuals, respectively, a rise of over 23.6%. This growth was faster in low—and middle-income countries before 2017.

The slowest growth of chain outlets in high-income countries was observed between 2016 and 2020. Overall, a consistent rate of chain outlet growth was observed in upper-middle income countries during the study period.

Between 2009 and 2023, the density of non-chain outlets decreased by 13.7%, with every nation outside of North America experiencing a reduction every year. The greatest decrease was observed in upper-middle income countries, followed by low-to-middle income and high-income countries.

The ratio of non-chain to chain outlets decreased by 61% during the study period, with low- and middle-income countries experiencing the largest decline despite having the highest number of non-chain outlets for each chain outlet.

Between 2009 and 2023, grocery sales from chain outlets increased by 8.5% in all nations included in the analysis, with South Asia experiencing the greatest increase of 6.68%. However, North America and sub-Saharan Africa did not report any changes in the percentage of grocery sales from chain retailers.

The sale of unhealthy foods increased by 4.9% between 2009 and 2023, with South Asia reporting the greatest annual increase during this period. No significant changes in the sales of unhealthy foods were reported in North America.

The percentage of unhealthy food sales from chain outlets also increased significantly by 10.9% during this period. In North America, over 80% of unhealthy food sales were from chain outlets, compared to 30% in South Asia.

Impact of the retail food environment on obesity

The prevalence of obesity increased by about 2% between 2009 and 2022, with all included geographical regions reporting a significant rise in obesity rates. The density of chain and non-chain outlets and the sales of unhealthy foods positively correlated with obesity rates. As the number of non-chain grocery stores reduced in certain nations, the likelihood of rising obesity rates increased.

Study takeaways

An increasingly corporatized retail food environment is associated with increases in obesity prevalence.

Large chain retailers gain the power to manipulate prices to maximize profits and increase the sale of ultra-processed, unhealthy, and packaged foods by largely dominating food markets. These factors can collectively manipulate customers to develop unhealthy food habits, potentially increasing the risk of developing NCDs like obesity.

The study findings emphasize the crucial need to monitor the role of retail food environment transformation on human and planetary health, especially in low—and middle-income countries, where this change is more rapid and pronounced.