This study explored the knowledge, attitudes, behaviors and barriers of obese adolescents in Erqi District, Zhengzhou City, China, in terms of weight loss management. The study adopted a cross-sectional design, collected data through a questionnaire survey, and used statistical analysis methods to explore the relationship between these factors and their association with socio-demographic characteristics. The study found that participants generally had misconceptions about health knowledge, had a negative attitude towards weight, rarely adopted weight-loss behaviors, and faced some barriers to health management. The study revealed a negative correlation between health knowledge and attitudes, a finding that challenges traditional ideas and suggests that simply increasing health knowledge may not be sufficient to change attitudes and behaviors. In addition, the study found that economic factors had a small effect on health-related dimensions, while BMI had a significant effect on knowledge and behavior dimensions. These findings highlight the need to consider the interaction of multiple factors when designing interventions for adolescent obesity, and to fully consider the local socio-cultural context. The results of the study provide a new perspective on understanding the problem of adolescent obesity in China, and also raise questions about current health education and intervention strategies. Future research can further explore the underlying reasons behind these findings, providing a scientific basis for the development of more effective strategies for the prevention and management of adolescent obesity.