Objective: The objective of this study was to evaluate the utility of wrist circumference (WrC) as a predictor of abnormal cardiometabolic risk (CMR) in children and adolescents with obesity. Methods: A cross-sectional study was conducted from July 2024 to September 2024. Children with obesity (aged 5-17.9 years) were categorized into metabolic syndrome (MetS) and non-MetS groups according to the International Diabetes Federation consensus criteria for pediatric MetS. Participants were divided into three groups based on their pubertal stages: pre-pubertal, pubertal, and post-pubertal. Results: A total of 307 children and adolescents with obesity were analyzed, comprising 160 females and 147 males, with a median age of 12.9 years (interquartile range 4.2). MetS was diagnosed in 94 participants (30.6%). Participants with MetS demonstrated significantly higher waist circumference, WrC, body mass index (BMI), blood pressure, serum triglycerides, fasting plasma glucose, insulin levels, and homeostasis model assessment of insulin resistance, alongside lower high-density lipoprotein-cholesterol (HDL-C) levels compared with those without MetS. In correlation analyses, WrC positively correlated with age, BMI, and various metabolic parameters, while it negatively correlated with HDL-C levels. Logistic regression analysis identified the pubertal stage and WrC as the strongest independent predictors of MetS. In the mid-pubertal group, a cutoff of 1.795 (96.2nd percentile) for the WrC z-score effectively predicted MetS in children with obesity. In the post-pubertal group, a cutoff of 1.805 (96.7th percentile) for the WrC z-score effectively predicted MetS in children with obesity. Participants with increased WrC presented significantly higher rates of hypertension and MetS in both the mid-pubertal and post-pubertal groups. Conclusions: This study demonstrates that WrC is significantly elevated in children with obesity diagnosed with MetS compared with their non-MetS counterparts. Furthermore, findings indicate that mid-pubertal and post-pubertal subjects with increased WrC are at a greater risk of presenting CMR factors than those with normal WrC values.