3 Key Ways GLP-1 Medications are Accelerating Retail E-Commerce Change

By Ross Kramer, Co-founder & CEO, Listrak

It’s hard to recall another pharmaceutical product that has had such a transformative impact on almost every industry, including the retail industry.

In the quarter-century that I’ve been working in e-commerce, I certainly can’t recall a ripple effect quite like the one being caused by GLP-1 medications.

With as many as one in eight American adults now taking the drugs, peak drug adoption may still be ahead. GLP-1 drug adoption is expected to surge due to new pill formats and significant price reductions, with Business of Fashion reporting that sales are projected to peak at $150 billion by 2035.

Meanwhile, the medications are quickly reshaping retail. Here are three retail e-commerce changes that GLP-1 medications are accelerating – and how marketers can adapt.

Driving a boom for fashion – but not across the board.

“As GLP-1 drugs become more accessible, more U.S. consumers are dropping sizes and may buy new clothes,” CNBC reported in April, citing estimates from equity research firm Bernstein, which found that apparel retailers could see an up to $13 billion annual boost in spending because of the medications.

If GLP-1 users each drop roughly three sizes and each person buys five to eight items per size they drop this year, that would translate to between 150 million and 700 million apparel items purchased, or a roughly 1% to 4% boost to the total unit volume of clothing sold in the U.S. per year, according to the report.

Likewise, H1 aggregated performance data from Listrak retail clients across email and SMS campaigns found that the Fashion category showed resilience in engagement, as purchasers sized down. Fashion email clickthrough rates held steady, bucking the H1 YOY decline seen across most retailers, achieving the highest Q2 email CVR and RPS to date (outside of holiday). Our Listrak analysts attributed the finding to the sector being fueled by demand from GLP-1 driven downsizing.

The boom is not across all categories however, with Bloomberg reporting that Macy’s is seeing its plus-size business soften.

To attract shoppers, brands and retailers “need to think about both the physical change and the emotional transformation that consumers are going through” and speak to them directly about how they can help, Kristen Classi-Zummo, an apparel industry advisor for Circana, told CNBC.

Accelerating the end of free shipping and returns.

In Listrak’s 2026 in our annual Beauty & Fashion Benchmark Report, we predicted the “death of free shipping and returns.”

Our analysts noted that, with margins shrinking due to tariffs and 16 percent of retailers’ sales returned in 2025, brands are no longer able to give these benefits away for free.

As we move into the second half of the year, this trend has only accelerated due to the impact of GLP-1 drugs. The Wall Street Journal recently reported that Americans on GLP-1s are “overwhelming retailers with their nonstop returns.” The report cited data from Impact Analytics which found that returns for medium, large and extra large items jumped the most.

With some retailers even introducing restocking fees, free shipping and returns will be offered only to highly loyal consumers, making these benefits a bonus associated with VIP customer status.

Making personal consumer connections more important than ever.

As consumers navigate the physical and emotional changes associated with GLP-1 medications, human connection in retail matters more than ever, and as a result, brands will need to craft more personalized touch points and in-store experiences.

Having a unified view of the customer – across channels, and including in-store data, becomes more critical than ever in allowing marketers to personalize across every stage of the customer journey.

The bottom line

From tariffs to AI to economic fluctuations, the pace of change for retailers seems faster than ever, and GLP-1 medications are another factor creating unprecedented change. 

The impact of these medications is serving to accelerate trends that were already in motion, such as the end of free shipping and the increasing importance of personalization. 

The retailers that win will continue to adapt their strategies, and stay laser focused on evolving consumer needs. 

Ross Kramer is the co-founder & CEO of leading cross-channel personalization platform Listrak.