Rationale, design, and methodology of My Body Is Fit and Fabulous at school (MyBFF@school) study: a multi-pronged intervention program to combat obesity among Malaysian schoolchildren

Childhood obesity has increased rapidly in recent years and is now a global epidemic. To combat this, MyBFF@school program, a multi-faceted obesity intervention incorporating physical activity in the form of small-sided games (SSG), nutrition, and psychology components for schoolchildren was designed. This paper is aimed at describing the protocol of the MyBFF@school program and presenting the baseline findings including the overweight and obesity prevalence. MyBFF@school is a school-based, cluster randomized controlled trial (C-RCT) study. The investigators selected government schools from Federal Territory of Kuala Lumpur, Selangor and Negeri Sembilan by stratified proportionate random sampling based on the multi-ethnic population and the urban-rural location of schools. Subsequently, the schools were assigned randomly to intervention and control groups. The intervention schools underwent MyBFF@school program, whereas the control followed standard school curriculum for a duration of six months. The intervention modules replaced the existing two physical education classes and one co-curriculum activity per week. Three assessments i.e. at baseline, month-3 and month-6 were conducted. Anthropometric, clinical examination, blood, physical fitness, nutrition, and psychology parameters were collected. Twenty-three out of 1,196 primary schools (seven interventions and 16 controls) and 15 out of 416 secondary schools (six interventions and nine controls). The investigators screened 11,950 primary (age 9-11 years) and 10,866 secondary (age 13, 14, 16 years) schoolchildren. The investigators found 3,516 primary schoolchildren (29.4%) and 2,910 secondary schoolchildren (26.8%) had BMI z-score of more than + 1SD who were eligible for the study. Of these, 39.7% (N = 1397) of the primary and 35.8% (N = 1041) of the secondary schoolchildren agreed to participate in the study. The mean (SD) characteristics for the participating primary and secondary schoolchildren were: BMI z-score, + 2.29 (± 0.81) and + 2.10 (± 0.71); waist circumference, 75.06 (± 9.6) cm and 85.5 (± 10.9) cm; percentage body fat, 37.8% (± 6.5%) and 39.2% (± 7.3%); and muscle mass, 14.7 (± 2.9) and 23.1 (± 5.2) kg respectively. MyBFF@school program, a school-based multi-pronged intervention was designed to combat childhood obesity. Screening of 22,816 primary and secondary schoolchildren found 29.4% of primary schoolchildren and 26.8% of secondary schoolchildren to be overweight and obese which reflect