The coexistence of hepatitis B and fatty liver can exacerbate liver damage and may also affect the treatment efficacy of hepatitis B virus. For patients with both hepatitis B and fatty liver, in addition to monitoring and treatment for hepatitis B, it is important to adjust their diet and lifestyle, limit fat intake, engage in physical exercise, and promptly eliminate fatty liver. For carriers of the hepatitis B virus, before initiating antiviral therapy, if liver function abnormalities occur, it is necessary to determine whether the liver damage is due to fatty liver or active hepatitis B virus. Treatments can include protecting the liver and eliminating fatty liver. If the response to treatment is unsatisfactory, antiviral treatment for hepatitis should be considered.