: The purpose of this review was to compare the effectiveness of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on cardiometabolic risk factors of obese children and adolescents. : Relevant studies published in PubMed, MEDLINE and Web of Science databases were searched. Only randomized controlled trials (RCTs) that examined the effect of HIIT and MICT on children and adolescents with obesity were included. Meta-analyses were conducted to determine the effect of HIIT on cardiometabolic risk factors using STATA software and potential moderators were explored (i.e., study duration, training modalities, work/rest ratio and work duration time). : Twelve RCTs involving 325 participants were included in the meta-analysis. HIIT showed more positive effects on maximal oxygen uptake (VO; SMD = 0.87, 95% CI: 0.39 to 1.35, = 0.000) and systolic blood pressure (SBP; SMD = -0.64, 95% CI: -1.05 to -0.22, = 0.003) than MICT. However, when compared with MICT, HIIT caused no significant differences in body weight, body mass index, body fat percentage, diastolic blood pressure and glycolipid metabolism markers. Furthermore, subgroup analysis showed that the effects of HIIT on VO and SBP were significantly different regarding protocol factors, such as modality, duration, training time, training settings, work/rest ratio and work duration. : HIIT has a positive role in promoting cardiometabolic risk factors in obese children and adolescents. Moreover, when compared with MICT, HIIT had a more significant effect on improving cardiorespiratory fitness and systolic blood pressure. The factors of HIIT protocol had an important influence on the intervention effects of childhood obesity.