Introduction <p>Evidence on left ventricular (LV) myocardial deformation, assessed by speckle tracking echocardiography (STE), in children and adolescents with obesity is scanty.</p> Aim <p>This meta-analysis aimed to provide a new piece of information on LV systolic function, phenotyped by global longitudinal strain (GLS) and LV ejection fraction (LVEF), in pediatric obesity.</p> Methods <p>Following the PRISMA guidelines, systematic searches were conducted in Pub-Med, OVID, EMBASE, and Cochrane Library to identify eligible studies from inception up to February 28^th 2025. Studies comparing LV mechanics in pediatric obesity and normal weight controls were included. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated using random-effects models to assess differences in GLS and LVEF. PROSPERO-ID: 635938.</p> Results <p>Twenty-seven studies including 1398 individuals with obesity and 2376 age-matched healthy controls were considered for the analysis. Pooled average GLS values were 20±0.4% in the control group and 17±0.5% in the obese group (SMD − 1.28±0.14, CI − 1.57/− 1.0, <i>p</i>&lt;0.0001). Overall, LVEF was lower in the obese group (SMD − 0.14±0.15, CI − 0.22/− 0.05, <i>p</i> &lt;0.001), although this parameter, at difference from GLS, in the majority of studies did not reach the statistical significance between groups. The metaregression analysis of GLS on BMI showed a significant inverse correlation between the two parameters (coefficient= − 0.33±0.11, <i>p</i>=0.003), this was not the case for LVEF.</p> Conclusions <p>Our data suggest that targeting LV mechanics may more accurately assess the systolic function in pediatric obesity; implementing STE in clinical practice may be highly useful in unmasking early LV functional alterations in this setting.</p> Graphical Abstract <p></p>