Obesity is frequently accompanied by metabolism-related diseases, serving as a critical etiological factor or risk factor and being associated with adverse clinical outcomes. Effective weight reduction has been demonstrated to ameliorate or even alleviate these comorbidities. However, lifestyle interventions alone often yield suboptimal efficacy, and behavioral resistance is often observed. In China, there are currently no specific guidelines targeting patients with behavioral resistance. In 2024, the Italian Association of Clinical Endocrinologists released the Guidelines for the Management of Adult Individuals with Overweight and Obesity and Metabolic Comorbidities that are Resistant to Behavioral Treatment, grounded in the latest evidence-based research. The guidelines primarily focus on pharmacological and surgical interventions in this patient population. This paper, in conjunction with Chinese guidelines, delves into the obesity evaluation and treatment strategies from the Italian guidelines, aiming to offer a reference for managing Chinese overweight or obese patients with behavioral resistance.

肥胖症常合并代谢相关疾病，是代谢相关疾病的重要病因或危险因素且与不良预后相关，有效减重可改善甚至缓解这些合并症。仅生活方式干预效果欠佳且行为治疗抵抗普遍，我国目前尚缺乏针对行为治疗抵抗患者的指南。2024年意大利内分泌学会基于最新循证研究证据发布了《成人超重、肥胖和代谢合并症行为治疗抵抗的管理指南》，重点探讨药物和手术治疗在这些患者中的应用。本文结合我国相关指南，重点分析该指南中肥胖症评估和治疗，以期为我国行为治疗抵抗的超重或肥胖患者管理提供参考。