<p>Distinct economic development priorities in underdeveloped regions prompt their decoupling approaches that must be different from others. Here, we focus on Gansu Province in China, a largely underdeveloped region that relies on a “Strong Industry” strategy to revitalize its economy amid enhanced regulatory requirements for environmental conservation. Results show that water–energy–carbon pressures rose by 70% following economic growth during 2002–2012 and then fell by 20% during 2012–2017. The economy has achieved strong decoupling from environmental pressures overall, mainly driven by scaling-up tertiary industry and trade-off of sharply decelerated growth of secondary industry. The pathways to decouple the overall economy from environmental pressures in underdeveloped regions can be established by balancing decoupling across sectors, rather than mandating it across all ones. This is particularly important for underdeveloped regions, which are in need of enhancing their economy under constraints of environmental protection.</p>