To examine the relationship between school recess policies, the quality of the recess environment and body mass index (BMI) among elementary school children. Observational. Data were collected at 23 schools across four geographically distinct regions of the United States. Measures included recess observations using the Great Recess Framework-Observational Tool (GRF-OT), recess policies were collected with the School Physical Activity and Policy Assessment, and BMI was obtained through height and weight measurements among 429 students in third and fifth grade. Results showed that school policies related to recess access significantly predicted children’s BMI, and school policies related to investment in recess significantly predicted recess quality as measured by the GRF-OT. Results from this study can be used to help inform future research regarding how school recess policies can impact child-level outcomes and the recess environment. •School’s investment in recess significantly predicts the quality of the recess environment.•Presence of school policies relating to access to recess significantly predicted one measure of children’s physical health.•Two thirds of participating elementary schools provide less than 30 minutes of recess per school day.