Due to the exponential growth in technology, exergames emerged as a potential tool to foster physical activity (PA) levels. This study provides an overall view of the literature on the effects of exergaming on physical fitness components among overweight and obese children and adolescents. A systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed in the PubMed, Web of Science, and Scopus databases. Among the 618 articles identified at the first screening stage, 17 were retained for analysis. The results indicate positive effects of exergaming interventions in body composition outcomes, cardiorespiratory fitness, muscular strength, and skills performance. Results from the randomized studies with the control group revealed significant effects of exergames in decreasing body mass index (mean difference = 0.24; 95% confidence interval [CI]: 0.06 to 0.43, P = 0.01) and increasing cardiorespiratory fitness (Hedges's g = 0.28; 95% CI: 0.09 to 0.46, P = 0.00). Although not statistically significant, participants submitted to exergames interventions also showed decreased body weight compared to their control peers. The results emphasize the ability of exergames to enhance PA levels and physical fitness components, which might influence the health status of overweight and obese youth. However, due to the limited number of studies included in the meta-analysis (n = 4), future randomized controlled experiments are still needed to improve the understanding of the impact of exergames interventions on physical fitness.