Research has shown that sports clubs call upon support from national sports federations (NSFs) to develop into a setting to promote health. The present study investigates how French NSFs themselves promote health. A two-step case study design was undertaken. A website analysis of 51 NSFs recognized as health promoting by the French National Olympic Committee was executed to examine health promotion (HP) visibility, and presence in strategic plans, committees and programs. Based on this search, four NSFs were chosen for an in-depth study, including interviews with representatives and a document analysis. Data were analyzed based on the Ottawa Charter strategies for HP. Results across all studied NSFs confirmed that NSFs are committed to HP, but HP is not mentioned directly, not visible, nor properly understood. Rather, a health topic approach is adopted, specifically focusing on strategies to enhance social and physical health. HP implementation lacks coordination, where resource investment is based on the sports ministry's focus on specific health topics, in a reactive manner, to implement national policies. NSFs" implementation of HP is very similar to that of a sports club, demonstrating that sports federations" vision and actions towards HP have to quit the silo and health topics approach in order to better support HP in their affiliated clubs. Future research should investigate determinants of HP implementation among NSFs. Practical implications include a recognition of HP beyond health topics, an integration of health as a transversal aim in NSFs" policies and programs, and a governance system to coordinate HP activities.