Health policy experts challenge the WHO's recent GLP-1 receptor agonist guidelines for obesity treatment in South and Southeast Asia, citing fundamental misalignment with regional healthcare realities. The analysis reveals these medications require lifelong use for sustained weight loss, cost significantly more than most healthcare budgets can accommodate, and lack safety data from South Asian populations who were underrepresented in clinical trials. Additionally, falsified GLP-1 products are already appearing in these markets, creating safety risks. This policy critique illuminates a critical tension in global health governance: universal treatment guidelines may inadvertently worsen health inequities when applied without contextual adaptation. The obesity epidemic in middle-income countries presents a different challenge than in wealthy nations, where healthcare systems can absorb expensive chronic treatments. The authors advocate for structural interventions addressing food systems and physical activity infrastructure instead of pharmaceutical solutions. This represents a paradigm shift from medication-first approaches toward addressing root causes of metabolic disease. The correspondence underscores how well-intentioned global health policies can become counterproductive when they ignore economic realities and healthcare capacity constraints in resource-limited settings.