Summary: In overweight and obese Malaysian primary schoolchildren, a 6-month school-based MyBFF@school program combining physical activity, nutrition, and psychological components produced significantly greater improvements than standard schooling in fasting insulin (-3.16 vs -1.05 microU/mL), HOMA-IR (-0.41 vs -0.17), and HDL-C (+0.34 vs +0.11 mmol/L), all with between-group p<0.001. BMI itself still rose in both arms, and the TG:HDL-C ratio improved equally in both groups.
PICO Summary
| Element | Detail |
|---|---|
| Population | Overweight and obese primary schoolchildren (BMI z-score > +1 SD) in Malaysia; cluster RCT across 23 of 1196 government schools; 1397 recruited, 683 with paired fasting bloods analysed (intervention 390, control 293). |
| Intervention | 6-month MyBFF@school program (physical activity, nutrition, and psychological components) delivered during school hours; n=390 with fasting bloods. |
| Comparison | Standard school curriculum without the added program; n=293 with fasting bloods. |
| Outcome | Fasting insulin fell more in the intervention arm (-3.16 microU/mL, 95% CI -4.07 to -2.25, p<0.001) than control (-1.05, 95% CI -2.28 to 0.18, p=0.095); between-group p<0.001. HOMA-IR: -0.41 (95% CI -0.63 to -0.19, p<0.001) vs -0.17 (95% CI -0.45 to 0.11, p=0.231); between-group p<0.001. HDL-C rose +0.34 mmol/L (95% CI 0.32 to 0.36, p<0.001) vs +0.11 (95% CI 0.08 to 0.14, p<0.001); between-group p<0.001. BMI z-score held steady in the intervention arm but rose in control (mean difference 0.03, p=0.026). TG:HDL-C ratio fell in both arms with no between-group difference (p=0.524). No ARR/NNT reported (continuous outcomes). |
MyBFF@school cardiometabolic outcomes
Cluster RCT · overweight schoolchildren · 6 months
A 6-month multi-component school program reduced fasting insulin and HOMA-IR and raised HDL-C more than usual schooling, but absolute BMI still rose and outcomes are surrogate markers.
Expert Commentary
This cluster randomised trial offers reasonably encouraging evidence that a structured, multi-component school program can shift cardiometabolic markers in children carrying excess weight. The verdict is cautiously positive: fasting insulin, HOMA-IR, and HDL-C all moved further in the intervention arm, and the between-group differences reached statistical significance. The signal on insulin resistance is the most clinically interesting, since it points toward a real reduction in early diabetes risk rather than cosmetic weight change. Some perspective is warranted, however. The headline outcomes are surrogate laboratory markers, not hard endpoints, and absolute weight was not reduced; BMI still climbed in both arms, with the program only preventing the further z-score drift seen in controls. The single most important limitation is attrition and selection: only 683 of 1397 recruited children had paired fasting bloods, so the analysed sample is roughly half of those enrolled, which can flatter an effect. The trial was unblinded by design, as school-based programs cannot be masked, and it was government-funded by the Ministry of Health rather than industry, which is reassuring. Can I use this with my patients? Partly. It is a fair basis to endorse comprehensive school-based programs for overweight children where they exist, but it does not justify promising individual families measurable metabolic gains. Wider trials reporting completer-adjusted analyses and longer follow-up are needed before firmer claims are made.
References
Jalaludin MY, Wan Mohd Zin RM, Roslan FA, Mansor F, Md Zain F, Hong JYH, et al. Cardiometabolic outcome of MyBFF@school intervention program among primary schoolchildren: a cluster randomized controlled trial. BMC Public Health. 2025;24(Suppl 1):3630. doi:10.1186/s12889-025-23546-x