Global food retail environments are increasingly dominated by large chains and linked to the rising prevalence of obesity

Retail food environments influence food purchasing and dietary patterns. A global analysis of the food retail landscape allowing comparisons across geographical regions is therefore needed to tackle diet-related non-communicable diseases. Here we examine trends in retail food environments from 2009 to 2023 across 97 countries, exploring associations with changes in obesity prevalence. Increases were observed in the density of chain outlets, grocery sales from chain retailers, unhealthy food sales per capita and digital grocery sales; non-chain outlet density and the ratio of non-chain to chain outlets declined over time. South Asia and low- and middle-income countries overall experienced the most rapid transformation. Changes in retail environments and the prevalence of obesity were found to be positively correlated. As retail environments become increasingly digital and dominated by large chains, important implications for diets and health should be expected, particularly in lower-income countries. Understanding the impact of retail food environments on human health is key to food systems transformation. This study examines global trends in retail food environments over the past two decades, showing that changes in these environments are associated with the prevalence of obesity.