Purpose – As posited by the ecological model of health, improvements in the nutrition and physical activity environments of worksites may facilitate healthier dietary intakes and physical activity patterns of employees. This cross-sectional study describes current policies and practices targeting these environments in five large Texas-based hospitals employing approximately 40,000 adults. The paper aims to discuss these issues. Design/methodology/approach – The environmental assessment tool survey, an observation tool, was used to assess these policies and practices in August and September 2012. Findings – Results demonstrated major policy and practice deficiencies, including a lack of policies supporting on and offsite employee physical fitness, no healthy catering or healthy meeting policies, minimal subsidizing of healthy food and beverage options, few health-promoting vending services, and no performance objectives related to worksite health improvement. Hospitals having an active employee wellness staff consistently performed better on implementation of policies and practices supporting healthy eating and physical activity. Practical implications – This study supports practice recommendations including engaging executive leadership to prioritize worksite wellness and using policies to create an infrastructure that promotes healthy eating and encourages physical activity among employees. Originality/value – This study is the first to compare and contrast the nutrition and the physical activity environments of large hospitals, allowing for the identification of common environmental barriers and supports across multiple hospital and foodservice systems.