Background: Aboriginal children are at increased risk for obesity and type 2 diabetes. Healthy Buddies [TM]-First Nations (HB) is a curriculum-based, peer-led program promoting healthy eating, physical activity, and self-esteem. Methods: Although originally designed as a pilot pre-/post-analysis of 3 remote Aboriginal schools that requested and received HB training, one school did not implement the program and was used as a control group. Outcomes included changes in body mass index z-score (zBMI), waist circumference (WC), blood pressure (BP), self-esteem, health behavior, and knowledge over 1 school year in kindergarten to grade 12 children. Results: There was a significant decrease in zBMI (1.10 to 1.04, p=0.028) and WC (77.1 to 75.0 cm, p less than 0.0001) in the HB group (N=118) compared with an increase in zBMI (1.14 to 1.23, p=0.046) and a minimal WC change in the control group (N=61). Prevalence of elevated BP did not change in the HB group, but increased from 16.7% to 31.7% in the control group (p=0.026). General linear model analysis revealed a significant interaction between time, group, and zBMI (p=0.001), weight status (p=0.014), nutritious beverage knowledge (p=0.018), and healthy living and self-esteem score (p=0.005). Conclusions: The HB program is a promising school-based strategy for addressing obesity and self-esteem in Aboriginal children. (Contains 3 tables and 2 figures.)