The global rush to embrace GLP-1 receptor agonists for obesity treatment could inadvertently widen health disparities in developing nations, where these costly medications may divert limited resources from more fundamental interventions. While WHO guidelines acknowledge these drugs' efficacy, their implementation in South and Southeast Asia raises critical questions about healthcare equity and sustainability. The medications require lifelong use to maintain benefits, with annual costs often exceeding entire healthcare budgets for individuals in low- and middle-income countries. Clinical trials predominantly enrolled Western populations, leaving uncertainty about effectiveness and safety profiles in genetically diverse South Asian populations who may respond differently to treatment. Beyond cost barriers, the correspondence highlights emerging safety concerns from counterfeit GLP-1 products flooding markets where regulatory oversight remains weak. These falsified medications pose serious health risks while exploiting desperate patients seeking weight loss solutions. The authors argue that conditional WHO recommendations shouldn't be interpreted as universal mandates, particularly in settings where basic nutritional needs remain unmet alongside rising obesity rates. Instead of pharmaceutical-first approaches, governments should prioritize structural interventions: improving food environments, enhancing physical activity infrastructure, and implementing 'double-duty' policies that simultaneously address undernutrition and obesity. This perspective challenges the increasingly medicalized approach to obesity management, suggesting that equity considerations must guide implementation of global health guidelines. For resource-constrained health systems, prevention-focused strategies may deliver greater population-level benefits than expensive pharmacotherapies that reach only privileged segments of society.