| Sumario: | Background: Precision health represents an emerging paradigm in public health that uses individualised risk profiles to guide targeted prevention strategies. In childhood obesity, early‐life determinants—such as genetics, growth patterns, family behaviours and environmental exposures—can inform interventions tailored to the specific needs of high‐risk populations. Traditional universal approaches have shown limited long‐term effectiveness, highlighting the need for more personalised prevention models. Objective: This systematic review aimed to (1) evaluate the effectiveness of tailored and risk‐based interventions for the primary prevention of childhood obesity in children aged 0–12 years, and (2) examine implementation characteristics and contextual factors influencing intervention outcomes. Methods: Following PRISMA 2020 guidelines, we searched six databases (PubMed, Embase, Web of Science, Scopus, PsycINFO and CINAHL). The protocol was registered on PROSPERO (CRD420251103591). Eligible studies included RCTs, quasi‐experimental, or pilot studies targeting obesity prevention using tailored or risk‐stratified approaches in children aged 0–12, reporting anthropometric or behavioural outcomes. Data extraction and quality appraisal were conducted independently by two reviewers, with synthesis via narrative and thematic methods. Results: Sixteen studies met inclusion criteria. Nine of 16 studies (56.3%) reported statistically significant reductions in BMI z‐scores or obesity prevalence, with effect sizes ranging from −0.10 to −0.54 in BMI z‐score units. Eleven studies (68.8%) observed significant improvements in dietary intake or physical activity behaviours. Culturally adapted, equity‐focused interventions showed higher uptake and effectiveness. Key challenges included limited scalability, short follow‐up periods and fidelity variability. Conclusions: Tailored, risk‐based interventions hold promise for reducing early obesity risk and improving health behaviours. Precision health strategies, especially those that are family‐centred and culturally sensitive, warrant further longitudinal evaluation to enhance equity and impact.
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