The gameplay is characterized by fine control and split-second timing, as the player runs and jumps through over 300 hazardous levels while avoiding obstacles.

[2][3] Players attempt to reach the end of each level, represented by Bandage Girl, while avoiding crumbling blocks, saw blades, and various other fatal obstacles.

[8] The Xbox Live Arcade (XBLA) version features an unlockable mode called "Teh Internets", which is updated with new, free, officially curated levels.

[11] The game's opening describes that Meat Boy (a boy born without skin) and his girlfriend Bandage Girl (a girl whose body is covered in bandages) love one another, though the antagonist Dr. Fetus (an intelligent fetus in a jar piloting a mechanical body) is unloved: thus, he hates everybody.

A large golem, "Little Horn", is created from these corpses, though it kills itself by repeatedly slamming its own head into the ground, allowing Dr. Fetus to escape whilst triggering a nuclear missile, which causes the rapture and opens a path to a ruined city.

Dr. Fetus tries to kill Meat Boy and Bandage Girl by triggering a self-destruct sequence, though is unsuccessful when Brownie reappears to saves the two: sacrificing himself.

A bonus chapter "Cotton Alley" appears after beating the game: in which Meat Boy is kidnapped by Dr. Fetus, and Bandage Girl must save him.

The original Meat Boy is an Adobe Flash game created by Edmund McMillen and programmed by Jonathan McEntee.

[13][16] Team Meat also includes soundtrack composer Danny Baranowsky and sound effects designer Jordan Fehr.

[14] The game was explicitly designed by the team to be reminiscent of Super Mario Bros.,[17] and McMillen considered it a tribute to Shigeru Miyamoto, the developer of Super Mario Bros.[18] McMillen worked on level design and artwork, while Refenes coded the game; it was tested primarily by the pair and their families.

[13][16] McMillen and Refenes lived on opposite sides of the United States, and met only a few times in person while working on the game.

The release date was pushed back to the fourth quarter because the developers wanted more time to create extra levels, such as the dark worlds.

As they were almost out of money, they did not believe that they could financially support themselves until the Spring event, but felt they had four months' worth of work left to complete on the game.

[19] For the final two months of development they worked daily, slept five hours a night, and frequently forgot to eat—a process that McMillen said he "would never voluntarily go through" again.

[22] According to McMillen, due to Microsoft's low expectations for the game, Super Meat Boy was lightly promoted.

The team described the effort required to finish the game for the promotion as "by far the biggest mistake [they] made during SMB's development".

It included bonuses such as behind-the-scenes videos, a sample disc of the game's music, and a Super Meat Boy comic.

The game was intended to be a different take on the Super Meat Boy concept that is more adapted to touch-screen controls than a direct port would be.

McMillen knew of Baranowsky's other work, and approached him late in Meat Boy's development, asking him to supply whatever tracks he had on hand.

[17] On October 26, 2010, the game's soundtrack was released as a download-only album via the online Bandcamp store titled Super Meat Boy!

[48] On January 11, 2011, Baranowsky and Team Meat released a special edition soundtrack on Bandcamp as both a downloadable and physical album.

After being showcased at the Penny Arcade Expo 2010, Super Meat Boy was declared Game of the Show by Destructoid and nominated for the same award by Machinima.com.

X-Play reviewer Alexandra Hall said the game had "riveting platforming action", and added that "Super Meat Boy's designers are masters of their craft.

"[4] A reviewer from GameTrailers stated that "the difficulty rides the perfect line between driving you utterly bonkers when you fail and making you feel like a platform pro when you succeed".

[4] Tom McShea of GameSpot praised the game's "precise control", "excellent level design", and "smooth difficulty curve".

Hatfield noted that the cutscenes had low production values, stating that "they don't have the polish of the rest of the game".

[67] Eduardo Reboucas of Game Revolution said that "a lot of the levels in Super Meat Boy depend a little too much on twitch reflexes and trial-and-error memorization".

He also stated that "there are some bits of toilet humor here and there that are duds", and that the game's high level of difficulty "will make most casual players shy away".

[82] Meat Boy has made cameo appearances in the video games Bit.Trip Runner, Bit.Trip Fate, and Bit.Trip Presents... Runner2: Future Legend of Rhythm Alien, as well as in Spelunky, Dust: An Elysian Tail, Ori and the Blind Forest, Retro City Rampage, ilomilo, and Indie Pogo.

[89] In August 2017, the game was confirmed for release for Microsoft Windows, Nintendo Switch, PlayStation 4, Xbox One, iOS and Android systems.