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.