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A growing coalition of health professionals and non-profit organizations are taking on new food initiatives in the health care sector that align with alternative agro-food ideals. These actions are largely inspired and legitimized by rethinking “healthy food” from a systems perspective. Actors are shifting from a traditional nutrition model focused on eating the right balance of nutrients and food groups to an environmental nutrition model—examining the public health impacts of social, economic, and environmental factors related to the entire food system. This chapter provides a history of the environmental nutrition movement in hospital foodservice. We profile a key non-profit organization that is driving new food initiatives in the health care sector—Health Care Without Harm. We detail how the approach is implemented in hospital foodservice and what the main barriers to implementation are. We then present a case study of the University of Washington Medical Center to demonstrate how implementing an environmental nutrition program works in practice, reflecting on the motivations, achievements, and lessons learned.