The World Obesity Federation has welcomed the first World Health Organization guideline recommending GLP-1 receptor agonists as a milestone in obesity care. Medical treatment should be provided as part of comprehensive, long-term management of obesity, not as a stand-alone solution. Rates of obesity and diabetes are rising in low- and middle-income countries. This WHO recommendation was welcomed by many as an expected egalitarian moment for the normalization of health coverage and fair pricing. The guidelines could contribute to the affordability of GLP-1 drugs through generic competition and joint procurement. A major risk to low-income health care systems is the political economy of introducing these drugs. In financially constrained systems with weak regulatory capacity, pharmaceutical innovation can be challenging. Treatment with GLP-1 drugs must not replace obesity prevention in these countries.