Introduction: Obesity policies in transitional countries are limited as most have needed to focus resources on reducing hunger, poverty, and infectious diseases. The Mekong Region is one such area that is still facing issues of undernutrition and infectious disease, yet has a growing population at risk of obesity related diseases. Such a dual burden creates a dilemma regarding which issue to address first, given limited resources. This review addresses this problem from a policy perspective. Materials and Methodology: Comparative analyses of literature reviews, existing policy, and previous research were synthesized among countries within the Mekong Region. Results: Traditional diets, quickly emerging fast food markets, and urbanization add levels of complexity to managing and creating obesity policy. Existing policies have not been successful and there are few measurable outcomes. Conclusion and Policy Implications: Obesity-related policies have been initiated in the Mekong Region, but with few resources and conflicting priorities, several countries are at risk of being left behind. Suggested policies in the region include utilizing mass media education campaigns, modeling other successful public health programs, and promoting culturally and regionally appropriate interventions.