Objective: In the USA there are rising rates of obesity among children, at least in part due to unhealthy eating and physical inactivity. Implementing school-based health interventions with elementary school children focused on youth empowerment could lead to improved health environments and behaviours. The purpose of the present study was to examine elementary students' perceptions of participating in a studentled school health improvement team. Empowerment theory guided the research, specifically the concept of including participants in programming to identify possible individual-level outcomes. Design: Qualitative research. Setting: One US elementary school formed a student-led school health improvement team, focusing on healthy eating and physical activity, comprising nine students and two adult co-advisers. Methods: Data collection included 19 individual interviews with students and advisers and four nonparticipant observations of team meetings and reform initiatives. To ensure the perceptions of the research participants' guided data analysis, analytic induction was undertaken using grounded theory. Results: Students and advisers shared similar perceptions that the student-led health reform process had a significant impact on several areas of students' life skills and health behaviours. Specifically, they identified improved leadership skills (assuming responsibility, self-confidence in public speaking and pride in becoming healthy role models) and health behaviours (dietary intake and physical activity) as outcomes of their emerging identities as health reform leaders. Conclusion: This study documented previously identified psychological empowerment outcomes, such as perceived control and proactive health behaviours, and additional positive outcomes, such as peer modelling. The findings suggest that team membership may positively impact on young people, which could support the inclusion of students as leaders in future interventions.