This study reviews obesity trends and physical education policies of 13 states with the highest and lowest youth obesity rates. A review of state policies for physical education was compared and analyzed. Although a majority of the states had physical education policies, they were typically not mandated and varied in time and grade-level requirements. However, little distinction in policies between states with higher and lower prevalence of obese youth was found. Financial and infrastructure support for the implementation and evaluation of physical education policies are needed, as well as innovative strategies including socioecological models to better address the obesity epidemic.