Background: Annual evaluations of the Mississippi Healthy Students Act of 2007 (MHSA) were conducted during 2009-2011 (years 1-3) among 4 stakeholder groups: (1) parents of public school students, (2) adolescents, (3) state-level policymakers (ie, legislators and other state officials), and (4) public school officials (ie, superintendents and school board members). Methods: We examine results from the first state-wide surveys conducted among purposive samples of superintendents (N?=?314) and school board members (N?=?689) on childhood obesity as it related to MHSA. These school officials were surveyed in years 1-3 to determine their knowledge or attitudes toward MHSA and support of potential policies, such as reporting results of student body mass index (BMI) assessments to parents. Results: Through the 3?years of the study, school officials were supportive of MHSA across a number of variables, although superintendents were consistently more supportive of current policies as compared with school board members. Conclusion: Results underscore the current and potential role of school officials relative to the process of fully implementing MHSA within all public school districts in Mississippi. Implications and 3 cases that illustrate diverse ways that school districts have chosen to implement effective school-based health initiatives are discussed.