This research addresses a lack of evidence on the positive and negative health outcomes of competitive online gaming and esports, particularly among young people and adolescents. Well-being outcomes, along with mitigation strategies were measured through a cross sectional survey of Australian gamers and non-gamers aged between 12 and 24 years, and parents of the 12–17-year-olds surveyed. Adverse health consequences were associated with heavy gaming, more so than light/casual gaming, suggesting that interventions that target moderated engagement could be effective. It provides timely insights in an online gaming landscape that has rapidly evolved over the past decade, and particularly during the COVID-19 pandemic, to include the hyper-connected, highly commercialized and rapidly growing online gaming and esports sector.