Objective To systematically synthesize qualitative evidence on the perceptions and experiences of healthy lifestyles among children and adolescents with overweight or obesity and their caregivers, and to provide evidence for the development of targeted lifestyle intervention programs. Methods Relevant qualitative studies were systematically searched in Chinese and international databases from database inception to February 2026. Two researchers independently appraised the methodological quality of the included studies. A meta-aggregation approach was employed to synthesize the findings. Results A total of 10 studies were included. Ten categories were identified and further synthesized into three levels of the Social Ecological Model. At the microsystem level, factors serving as prerequisites for adopting healthy lifestyles included low self-efficacy, perceptions of health-related concepts, excessive psychological burden, and inadequate self-control. At the mesosystem level, support for achieving healthy lifestyles was reflected in dietary influences and perceived support. At the macrosystem level, multiple factors affected the adoption of healthy lifestyles, including easy access to unhealthy foods, excessive academic burden, concerns about neighborhood and community environments, and expectations of support from healthcare professionals. Conclusion Children and adolescents with overweight or obesity and their caregivers demonstrated limited awareness and understanding of healthy lifestyles and encountered multiple barriers to adopting healthy behaviors. Future interventions should focus on improving health-related knowledge and addressing psychological experiences, while promoting collaboration among families, schools, healthcare professionals, and communities to establish a comprehensive health support system for children and adolescents.