This network meta-analysis aimed to assess the relative efficacy of macronutrient dietary groups with varying carbohydrate, fat, and protein ratios on weight control and cardiovascular risk factors improvement in adults. We searched PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Web of Science Core Collection, and ClinicalTrials.gov from inception to 30 November 2024, as well as reference lists of related systematic reviews. Eligible randomized controlled trials (RCTs) were included. Literature screening, data extraction, and risk of bias assessment were conducted independently by two reviewers. The changes in body weight, blood glucose, systolic blood pressure, diastolic blood pressure, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, triglycerides, and total cholesterol were the study outcomes. Utilizing a Bayesian framework, a series of random-effects network meta-analyses were conducted to estimate mean difference (MD) with 95% credible interval (CrI) and determine the relative effectiveness of the macronutrient dietary groups. The quality of evidence for each pair of dietary groups was assessed based on the online tool called confidence in network meta-analysis (CINeMA). This study initially identified 14,988 studies and ultimately included 66 eligible RCTs involving 4301 participants in the analysis. The very low carbohydrate-low protein (VLCLP, MD -4.10 kg, 95% CrI -6.70 to -1.54), the moderate carbohydrate-high protein (MCHP, MD -1.51 kg, 95% CrI -2.90 to -0.20), the very low carbohydrate-high protein (VLCHP, MD -1.35 kg, 95% CrI -2.52 to -0.26) dietary groups might lead to weight loss compared with the moderate fat-low protein (MFLP) dietary group. Among the dietary groups relative to the MFLP dietary group, the moderate carbohydrate-low protein (MCLP, MD 0.09 mmol/L, 95% CrI 0.02 to 0.16) and VLCHP (MD 0.16 mmol/L, 95% CrI 0.08 to 0.24) dietary groups were less effective in lowering HDL cholesterol, and the VLCHP (MD 0.50 mmol/L, 95% CrI 0.26 to 0.75) dietary group was less effective in lowering LDL cholesterol. In terms of triglyceride reduction, the MCLP (MD -0.33 mmol/L, 95% CrI -0.44 to -0.22), VLCHP (MD -0.31 mmol/L, 95% CrI -0.42 to -0.18), VLCLP (MD -0.14 mmol/L, 95% CrI -0.25 to -0.02), and moderate fat-high protein (MFHP, MD -0.13 mmol/L, 95% CrI -0.21 to -0.06) dietary groups were more efficacious than the MFLP dietary group, while any pair of dietary group interventions showed minimal to no difference in the effects on blood glucose, blood pressure, and total cholesterol. High or moderate certainty evidence reveals that the VLCLP dietary group is the most appropriate for weight loss, while the MCLP dietary group is best for reducing triglycerides. For control of blood glucose, blood pressure, and cholesterol levels, there is little to no difference between macronutrient dietary groups. Additionally, future studies in normal-weight populations are needed to verify the applicability of our findings.