GLP-1 guidelines amid an obesity epidemic: a poor fit for the Global South

The recent World Health Organisation guideline on glucagon-like peptide-1 receptor agonists for obesity has generated intense interest in their use across low-and -middle-income countries. This correspondence examines the suitability of a pharmacotherapy-centred strategy for South and Southeast Asia, where obesity is rising rapidly but health system remain resource-constrained. The article summarises evidence on the growing burden of high body mass index, the high cost and limited reach of these medicines, and the need for prolonged or lifelong treatment to sustain weight loss and metabolic gains. It also highlights signals of harm from falsified and substandard products and the under-representation of South Asian and other marginalised populations in pivotal clinical trials. In light of these factors, the correspondence argues that conditional global recommendations should not be interpreted as a mandate for widespread deployment of these agents in the Global South. Instead, it proposes that governments prioritise structural measures to improve diet and physical activity, double-duty actions that addresses both undernutrition and obesity, and investments in pharmacovigilance and regulatory capacity. Any future use of these medicines should be tightly targeted, carefully monitored and explicitly assessed for equity implications. The correspondence aims to support policy makers and clinicians to interpret global guidance in a way that is ethically sound, fiscally realistic ad responsive to local patterns of malnutrition and disease.