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Abstract

There is growing evidence of the harms caused by the mass production and consumption of animal products and the benefits of plant-based diets – ethically, environmentally, and for human health. While human and planetary health are increasingly viewed as interconnected, the healthcare system remains largely anthropocentric and disengaged from sustainability goals. Given its influential role, the healthcare system can either support or hinder the acceptance of plant-based diets as part of addressing ecological and public health crises. This article explores the experiences of vegan parents in their interactions with primary care providers (PCPs) based on qualitative interviews with 25 vegan parents. Our findings indicate that while some parents reported neutral or supportive experiences, negative and unsupportive interactions with PCPs were more typical. Fear of stigma led some to avoid disclosing their family’s veganism altogether. These findings highlight important concerns about the quality and equity of healthcare, patient autonomy, and the healthcare system’s potential role in supporting and promoting plant-based diets and sustainable food practices more broadly. As powerful institutional authorities, the healthcare system and its key actors, such as PCPs, can and should support moving towards more sustainable and ethical food and health futures.

Keywords

plant-based diets veganism vegan parents family medicine primary care providers

Introduction

In recent years, plant-based diets have gained increasing popularity in many Western countries. There is by now ample evidence of the negative impacts of the mass production and consumption of non-human animals and the benefits of whole food plant-based (WFPB) diets, from the considerations of animal ethics, environment/climate and human health. Animal-based diets have been established as a key driver of the current climate breakdown (Arias et al., 2021; Clark et al., 2020; Twine, 2024), and it is not possible to meet internationally set climate targets without moving towards plant-based food systems (Clark et al., 2020). Also, the heavy consumption of meat and dairy integral to many Western diets is responsible for various lifestyle diseases (Micha et al., 2017). Further, factory farming on a mass scale has also been identified as a public health hazard (Brown, 2004; Chemnitz and Becheva, 2021; World Health Organization, 2017).

In response to this mounting evidence about the detrimental global effects of consuming non-human animals, dietary guidelines of several Western countries are increasingly recommending a reduction of animal products in diets and the consumption of more plant-based, climate-friendly foods (e.g. Blumhoff et al., 2023; Springmann et al., 2020), as human and planetary health are increasingly seen as intertwined (Gibbs and Cappuccio, 2022; Springmann et al., 2016; Taylor, 2024; Willett et al., 2019; Rockström et al., 2025). At the same time, WFPB diets have been deemed by the world’s leading nutritional experts as suitable for human beings at all stages of life, including in childhood (see e.g. Melina et al., 2016; The British Dietetic Association, 2021). Also, their benefits in preventing various lifestyle diseases have been widely recognised (Melina et al., 2016).

Despite the gradual intensification of various human-induced ecological crises in the Capitalocene¹ and knowledge of how the consumption of animal products contributes to these, institutional support for plant-based diets and veganism has lagged behind, with national governments, transnational bodies and other key institutions not making sufficient effort to support moving away from animal-based food systems. In fact, key transnational institutions such as the European Union, as well as national governments, continue to heavily subsidise the meat and dairy industry (Kortleve et al., 2024). An analysis of national dietary guidelines of 85 countries found that they tend to be largely incompatible with global health and environmental targets (Springmann et al., 2020). Thus, efforts to move towards more sustainable food practices have been left to individuals first and foremost.

The healthcare system is an institution that plays a significant role in supporting or hindering the acceptance and adoption of plant-based diets. The accepted knowledge of nutrition (including national dietary guidelines) and the attitudes and practices of healthcare professionals regarding diets and their health impacts are of key importance in moving towards more sustainable lifestyles. Thus far, the role of the healthcare system and healthcare professionals has not been sufficiently examined in this regard (for exceptions, see Aavik, 2021; Bivi et al., 2021; Borisova et al., 2023; Francis and Miele, 2025; Jirovsky-Platter et al., 2024).

As a novel focus, this article studies the role of primary care providers (PCPs) – as institutional actors – in supporting plant-based diets and vegan lifestyles, especially those of families, from the perspective of vegan parents. How vegan parents and other families following (mostly) plant-based diets can raise their children according to these values and food practices is of key importance regarding the adoption and popularity of plant-based eating in future generations.

We focus on the experiences of vegan parents with PCPs and their expectations of these healthcare professionals, drawing on qualitative interviews with 25 vegan parents based in Estonia. Our key research questions were:

What are the experiences of vegan parents in their interactions with PCPs?

How do they navigate the disclosure of their family’s veganism to PCPs and how do they rationalise this choice?

What strategies do they use to cope with actual or anticipated negative responses from PCPs?

From the perspective of vegan parents, how can PCPs better support vegan families?

What expectations do vegan parents have of PCPs in terms of knowledge, communication, and care practices?

While we draw on the experiences of vegan parents, our findings and implications concern others (including families) who seek to make healthier and more sustainable food choices. Thus, this article contributes to understanding the role of PCPs and the healthcare system towards more sustainable lifestyles more broadly.

Conceptual background and previous research

In many Western countries and elsewhere, plant-based diets and veganism are on the rise, and becoming visible and accepted, as increasingly more people seek to pursue more sustainable, healthier and/or animal-friendly ways of life. This includes a rising number of children raised on plant-based diets².

While vegan parenting or raising children on plant-based diets is typically regarded as pursuing an alternative lifestyle or diet, this practice is at the same time inherently political, which, at least for vegans, goes beyond simply eliminating animal-based foods from their diet³. Vegan parenting could be seen as an everyday practice of cultivating alternative (vegan) imaginaries regarding more sustainable and ethical human-animal relations. As such, it is a powerful challenge to the anthropocentric social order, socialisation, institutions and futures. It is a particularly relevant intervention in the Capitalocene, characterised by multiple intertwined ecological, social and health crises intensified by animal-based diets, as outlined above.

As noted earlier, there is, thus far, little institutional support for a transition to plant-based diets and food systems in most countries (see Aavik, 2017, 2021). Drawing on Gramsci’s concept of cultural hegemony, social institutions can be understood as enforcers of normative social order, maintaining social norms and advancing the interests of dominant groups. Institutions are deeply rooted in speciesist ideology (Nibert, 2002) which they uphold through various direct and more tacit means, for instance through rendering deviant and disciplining those who challenge hegemonic norms.

These insights also apply to the healthcare system, an anthropocentric institution concerned with human health first and foremost. It has historically depended on and continues to rely on the exploitation of non-human animals to advance medical knowledge, as evidenced by the still prevalent animal experimentation (see e.g. Birke, 2012). Standard medical models of the healthy body assume it is sustained by animal products (see e.g. Birke, 2012) and academic discourse on medicine, health and healthcare remains largely anthropocentric⁴.

In many countries, healthcare professionals lack experience with and knowledge of patients on plant-based diets, including children, despite increasing exposure to them. This has in part to do with minimal training on nutrition and especially WFPB nutrition as part of medical education (see e.g. Morton et al., 2021). Also, scepticism and caution towards children’s plant-based diets could in part stem from contradictory, outdated and methodologically inadequate academic research circulating in the scholarly discourse on this matter (Jakše et al., 2023). In recent years, amidst intensifying global ecological and health crises, increasingly, human and planetary health are being seen as interlinked (Gibbs and Cappuccio, 2022; Springmann et al., 2016; Taylor, 2024; Willett et al., 2019; Rockström et al., 2025). Calls have been made and some initiatives taken to highlight the role of health care organisations and professionals in climate change mitigation (for an overview, see Iyer et al., 2022). However, most of these initiatives have not called for an elimination or reduction of animal products from the human diet (see e.g. Iyer et al., 2022). The national dietary guidelines of some countries have only recently started to pay some attention to the environmental impact of food (see e.g. Nordic Nutrition Recommendations – Blomhoff, 2023).

Existing studies on vegan families and parenting are scarce (see e.g., Alvaro, 2020; Ballif, 2024; Bivi et al., 2021; Hunt, 2021; Milburn, 2020; Phillips, 2019; Ryley, 2024) and do not often draw on empirical data. Broadly, this work has helped to shed some light on what vegan parenting means to those practising it and the difficulties and dilemmas vegan parents face in attempting to raise their children according to vegan values in anthropocentric societies reliant on the exploitation of other animals.

Existing research on the experiences of vegans and others following plant-based diets in the healthcare system is scarce, especially concerning children. While many countries, including Estonia, have clear guidelines for healthcare professionals on how to monitor children’s growth and development, most countries lack national guidelines on how to monitor vegan patients specifically, including children (for an exception, see the French guidelines on this – Lemale et al., 2019). Some national and transnational expert groups however have published guidelines on this (see e.g. Baroni et al., 2019; Melina et al., 2016).

Previous research has found that vegans are constructed as deviant in medical encounters (Aavik, 2021). Qualitative studies conducted in Estonia, Austria, Italy and the Czech Republic have found that vegans experience criticism and judgment from healthcare professionals due to following a plant-based diet, resulting in some vegans avoiding visiting doctors or disclosing their veganism (Aavik, 2021; Bivi et al., 2021; Borisova et al., 2023; Francis and Miele, 2025; Jirovsky-Platter et al., 2024). This bias experienced by vegans has included doctors attributing various health issues to their ‘unconventional’ diet, without additional investigations to rule out other causes. A recent study conducted in the UK (Francis and Miele, 2025) found that vegan mothers in the UK experience stigma and mom-shaming in the healthcare system. The same study indicated a lack of knowledge on veganism by healthcare professionals.

Overall, these studies suggest that vegans expect competence and impartiality from healthcare professionals regarding their nutritional choices. The healthcare system and healthcare professionals communicate explicit and tacit messages to patients, including children, regarding appropriate eating habits and the links between diet and health. Thus, this institution plays a key role in normalising or challenging animal-centered diets.

The world’s largest organisation of food and nutrition professionals, the Academy of Nutrition and Dietetics, states that appropriately planned vegetarian, including vegan diets, are healthful, nutritionally adequate, and may provide health benefits in preventing and treating certain diseases, and are appropriate for all stages of life, including childhood and adolescence (Melina et al., 2016). Similarly, The British Dietetic Association (2021) states that plant-based diets can support healthy living at every age and life stage.

Due to ethical reasons, only a handful of studies assessing vegan children’s development and health exist. A systematic review and meta-analyses on the health aspects of vegan diets among children and adolescents point to both risks and benefits associated with a vegan diet among children (Koller et al., 2024).⁵ Based on the studies the authors analysed, vegan children and adolescents had higher intakes of carbohydrates, fibre, PUFA, vitamins B12, C and E, folate, magnesium, iron, and potassium. In comparison, their intakes of protein, MUFA, SFA, vitamin B2, and cholesterol were lower. Ferritin, HDL, LDL levels, and height were lower in vegans, although the latter difference was driven by a structural imbalance in age between the groups in one included study (Koller et al., 2024).

Research participants, method, materials, and ethics

This article is based on semi-structured qualitative interviews with 25 vegan parents⁶ in Estonia conducted by the first author. Most of the research participants were found through local vegan-themed Facebook groups, including one on vegan parenting. A few research participants were approached directly based on previous acquaintance or recommendations from other participants. The sample included four non-Estonians and a few ethnic Estonians who have lived abroad for an extended period of time. Six fathers participated in the study, two of whom were interviewed together with their female partner/mother of their children. The age range of the interviewees was between 28 and 47 and all had at least one child under 18. The ages of the children ranged from newborns to young adults. Most participants lived in urban areas and were relatively privileged in terms of class and educational backgrounds. All interviewees gave informed consent to participate in the study. The study received approval by Tallinn University’s Ethics Committee (22. 09. 2023, decision no. 21).

The average length of the interviews was 76 minutes. Interviewing was inspired by narrative approaches, aiming to elicit detailed and storied accounts of experiences (see e.g. Lawler, 2002). The interview guide included narrative open-ended questions and keywords referring to themes to be covered – the specific wording and order of the questions varied in each interview, depending in part on the research participant’s narrative flow. The interviews focused on various aspects of vegan parenting, with a particular emphasis on the parents’ experiences in the education and healthcare systems as well as their expectations of these institutions and the state.

The interviews were transcribed and analysed using thematic analysis (Braun & Clarke, 2022). Qualitative analysis software Nvivo (Lumivero, 2023) was used to analyse the data. Both authors analysed the data, complementing each other’s perspectives and disciplinary backgrounds (the first author is a sociologist and gender scholar, and the second author is a scholar of family medicine and a practising PCP). Open coding was first conducted, after which codes were grouped into themes following Braun and Clarke’s (2022) guidelines. The final themes emerged primarily through inductive analysis, but were also partially informed by initial theoretical considerations and the study’s focus, as reflected in the interview guide – for example, themes related to vegan parents’ experiences within institutions, specifically, education and healthcare. Most codes were semantic, though latent codes were also used to capture implicit references to inequality in vegan parenting, a key interest of the authors (see Braun & Clarke, 2022).

Both authors identify as vegans; the first author is also a vegan parent – an identity that shaped all stages of the research, from setting the focus and developing the conceptual framework to conducting interviews and interpreting findings. Our approach was grounded in feminist epistemology and methodology, emphasizing engaged research, the rejection of value-free scholarship, and collaborative knowledge production with participants (see e.g. Harding & Norberg, 2005; Jackson et al., 2024). As vegan scholars, we aim to promote institutional support for veganism and WFPB diets, drawing on evidence-based insights into the ethical, health, and environmental consequences of consuming non-human animals.

Our position in relation to the participants was both insider (as members of the vegan community) and outsider (as academic researchers). The insider role facilitated access, built trust, and reduced power imbalances, encouraging participants to share openly about vegan parenting. However, it also brought certain taken-for-granted assumptions about the research participants and vegan parenting that shaped the research process. The first author, who conducted the interviews, emphasised reciprocity and a commitment to giving back to the community⁷. Our academic identities and previous work on veganism likely helped to legitimise the study in the eyes of participants.

We use excerpts from the interviews to illustrate our findings. Interviews were conducted in the Estonian language (except one, conducted in English), we have translated the excerpts into English. Pseudonyms are used to refer to the research participants, and all data that would enable the identification of them or their children has been hidden.

Context of the study

As a small Northern European country with a state socialist past, Estonia is an interesting context in which to study the experiences of vegan parents in the healthcare system and the role of PCPs in supporting a transition to plant-based diets. The Estonian case is an example of a national context where animal-based food is ubiquitous, with strong historical traditions. This is supported by an entanglement of nutrition science with the interests of meat and dairy producers (Aavik, 2017). The consumption of meat and dairy is still regarded as essential in the national nutrition recommendations (Aavik, 2017). However, the ethics (and health and environmental impacts) of eating non-human animals are increasingly being challenged by the growing vegan and animal advocacy movements. Despite this grass-roots activism, institutions in Estonia – with the healthcare system as a prime example – remain rather sceptical of plant-based diets and veganism, more so than in many other Western countries (Aavik, 2017, 2021). As such, the Estonian case helps to illustrate institutional resistance⁸ to moving towards plant-based food systems and the efforts of vegan parents to maintain their family’s veganism in anthropocentric social structures.

According to the Estonian Constitution, political and other beliefs – including veganism – are protected, and individuals should not face discrimination based on them. The Estonian Code of Medical Ethics similarly prohibits discrimination against patients based on their beliefs. While healthcare professionals are expected to follow these regulations, their practical enforceability and the handling of violations remain unclear. To date, no legal cases have been brought in Estonia against healthcare providers for breaching these protections.

In Estonia, the family medicine centre is the first point of contact for most health concerns. PCPs working in these centres, mainly family doctors and nurses, play an essential role in health education and prevention, including monitoring children’s development, organising vaccinations and advising people on healthy lifestyles. Every insured person living permanently in Estonia has a family doctor appointed by the state or chosen by themselves. One family doctor can have one patient list at a time, typically consisting of 1600 ± 400 patients. In Estonia, family doctors exercise a partial gatekeeping function and are directly funded by the Estonian Health Insurance Fund (Kasekamp et al., 2023; The Estonian Health Insurance Fund, 2017). Given these critical roles of PCPs in Estonia, it is noteworthy that their training includes only minimal content on food and nutrition. During their undergraduate medical studies, Estonian doctors learn the principles of healthy eating only as a part of the second year course Health Promotion (4 ECTS) (The University of Tartu, 2021).

Analysis and findings

We present our findings according to the key themes that we identified in our thematic analysis, guided by our research questions.

Notifying the PCP about the family’s/children’s veganism

Roughly half of the interviewed vegan parents had mentioned to their PCP that they are raising their child on a plant-based diet, while others withheld this information. The decision around informing the PCP about the family’s veganism was typically not straightforward or easy. It involved careful deliberation by the parents regarding whether, when and how to communicate this.

Among those who had informed their PCP about their own and their children’s veganism, several did so gradually and cautiously, carefully choosing when and how to disclose the information. This caution was exercised to avoid potential prejudice. The decision whether to inform their PCP about veganism was in part based on their prior interactions with the doctor, in which they attempted to assess whether and how open the PCP would be to this information. If, during these prior encounters, they developed a sense that the PCP might have a potentially supportive or at least neutral attitude towards veganism, they were more open to gradually sharing more about the family’s diet, eventually fully disclosing the family’s vegan lifestyle:

Jürgen, 36, two children: At first, with the family doctor. . . we didn’t really dare to just outright say, like, “Hi, we’re vegan parents, our child is vegan, and if that doesn’t suit you, we’ll find another doctor.” We didn’t approach it like that. In the beginning, when she asked what we had been giving the child, we just said we’d given this and that. And when she asked, “Have you given meat as well?”, we said something vague, like, “Well, he doesn’t really like it.” And then gradually, with each following visit, we became more confident about saying directly that, actually, we don’t plan to give him any. And now she knows—she’s known for the past couple of years—that we really don’t give him meat, and she knows, essentially, that we are. . .that we have a vegan child.

Informing the PCP about one’s family’s veganism was framed by a few as a conscious and strategic choice, believing it to be important information that the doctor should know when working with patients to make more informed treatment decisions or to provide relevant nutritional advice:

Kristin, 28, one child: I actually do it [tell the family doctor that my child is on a plant-based diet] deliberately. I say it because I want to show family doctors that this is normal, that people like us exist, and maybe that will get things moving at a higher level. Like, look, there are more and more vegan children, maybe they should be supported somehow so that the kinds of things the media sometimes writes about wouldn’t happen. [. . .] So in that sense, it was completely intentional. I wasn’t afraid of any disapproval. [. . .] Well, I actually think it’s a good thing if the family doctor knows about our diet, because then they can take it into account—for example, maybe it means doing some blood tests more frequently, especially when it comes to our child, and I’d be totally fine with that. [. . .] Since many vegan parents don’t even tell their family doctor that they’re vegan, the doctors have no idea how many of us there really are.

In contrast to these experiences of (gradual) disclosure were those where parents made a decision not to inform the doctor of their own and especially their children’s veganism. This was justified by not wanting to risk damaging their relationship with the PCP. Vegan parents suspected their PCP and/or nurse would be prejudiced against veganism from the outset and would start linking all of the child’s health issues to their diet:

Interviewer: You haven’t told the family doctor?

Helene, 35, one child: No, I haven’t, yeah. I just haven’t seen the reason why I should say that. Everything has been fine, they’ve said that everything is developing really well, there haven’t been any deficiencies and. . . There was this one article that came out once, it was a family doctor’s opinion piece, and to my horror I realised it was written by my health care provider. And there was this really awful sentence in it, something like, “We have several vegan patients, and our position is that parents should stop the vegan diet for the sake of the child’s health, but the parents don’t listen and keep demanding other things, not realising that the issue lies there.” Something like that. And basically, what I took from it was that the doctor’s attitude is that if they hear someone is vegan, they immediately jump to the conclusion that all health issues stem from that. [. . .] I really don’t want that kind of attitude in my own case, like, if I say we’re vegan, and then whatever happens, that’s the first thing they blame. So yeah, I haven’t said anything—for the sake of getting better service and not having to hear opinions that actually have nothing to do with health.

Research participants typically assumed that PCPs have limited knowledge about WFPB diets and their health effects and would be particularly prejudiced and misinformed about children’s veganism. Therefore, some felt that informing the PCP about the family’s and especially their children’s diet was unnecessary and would not contribute to making the correct diagnosis or supporting the treatment process. Instead, it was feared that disclosing this information would lead to additional complications in the patient-doctor relationship:

Stella, 33, one child: The reason I’ve avoided saying it is simply because I think it [veganism] would end up being blamed for everything, no matter what the issue is. It just feels like a waste of energy, honestly. Because without that knowledge, the doctor actually looks into other things, you know. And well, I also think that vegans are quite aware [about nutrition], maybe even more aware than the average person, like, they pay closer attention to certain things and so on. So, if I myself felt that if something might be diet-related, then of course, I’d bring it up and maybe we’d discuss it. But otherwise, yeah, I can just imagine them blaming even an ear infection on veganism. [. . .] I just haven’t wanted to go down that path of conflict, not as long as I can avoid it.

As Stella’s experience suggests, the decision of vegan parents to disclose their children’s veganism was also seen, at least by some, as something to be done only if deemed necessary in a particular context, where vegan parents assumed that the child’s health problem in question might be diet-related.

Experiences with PCP reactions after disclosing veganism

Those who had informed their PCP about their family’s veganism reported a range of reactions – from sceptical or even hostile attitudes to neutral and positive feedback. Some noted that the doctor’s attitude had become more informed and supportive over the years, especially if the child had not experienced any or significant health problems. The research participants linked these developments to growing awareness among PCPs about the health impacts of plant-based diets, in the context of generally increasing societal knowledge on and acceptance of, if not entirely plant-based diets, then at least moving away from meat-heavy diets, promoted by key international and national nutrition bodies. A few also noted that their PCP had admitted to having insufficient expertise in the area of nutrition and had either provided recommendations on where to seek further advice or had consulted with a relevant specialist themselves:

Jürgen, 36, two children: Actually, our experience with her has been very good. She was never very forceful, like saying, “You have to do this [give animal products to your children], and if you don’t, you’re bad parents.” She didn’t say anything like that. She implied that it would be better to do it, but she hasn’t even done that recently, probably seeing that everything is going well in terms of development, and the blood tests are fine. And maybe she has also educated herself a little bit here and there. She’s more of a younger doctor, not really the old-school type, with whom it might be more difficult. So, at first, maybe we were a bit unsure if we should tell her or what she would think, but now she thinks very well of it. Or, well, let’s say, not exactly “very well,” but neutrally—she doesn’t have anything negative to say.

Those who experienced neutral or positive reactions from their PCP suggested that this might have been due to the fact that their children had not experienced any or significant health issues. Yet, the parents assumed that in the case of health problems, they would have experienced a negative reaction:

Marianne, 31, two children: We’ve had a very positive experience, but that’s only because our test results are good. I’m absolutely convinced that if we had an iron deficiency, which actually is common among omnivore children in my circle, I’m sure the feedback would be completely different, and the problem would be veganism, not the fact that many children have an iron deficiency. So, we’ve been lucky in that regard.

Vegan parents who encountered sceptical and prejudiced attitudes from their PCPs upon disclosing their children’s veganism, shared experiences where the doctor began linking various unrelated health issues to veganism, expressed misconceptions about veganism, or provided recommendations for the vegan patient and their children to consume animal products:

Marten, 39, one child: The doctor didn’t really let it go throughout the entire visit. In the end, she still said, “What are you messing around with those plants for, you have to eat everything” [. . .] So yeah, with the doctor, it is what it is. Honestly, I’m not really eager to go back there. It would be really great if we had a vegan doctor.

Stella, 33, one child: But then, when he [her son] was. . . I don’t remember how old he was, maybe a few months later or around ten months old, when I started giving him that food [animal-based] according to the doctor’s recommendation, he never actually wanted it, and he had a major block about it all the time. So yeah, in hindsight, maybe that’s my regret, that at certain moments, under the doctor’s influence, I still forced him to eat it.

As these excerpts indicate, the consequences of experiencing negative reactions to one’s own and one’s children’s veganism can be serious. The most typically mentioned consequences were avoiding visiting the doctor altogether or going against one’s ethical beliefs by feeding animal products to one’s children.

In case of negative experiences, it is not easy to change the PCP in Estonia, as the patient lists of preferred PCPs could be full:

Lea, 29, one child: It was still, let’s put it this way, a very, very unpleasant experience for me. I felt for a long time after that I didn’t want to go back at all. I looked for other family doctors, but, well, it kind of. . . since the regular monthly visits ended when my child turned one, at some point I just gave up because I realised that since I live in [name of a rural area], I don’t have much of a chance of finding anyone who would be more informed about veganism, raising vegan children, plant-based diets in general, and what it entails and what it doesn’t, and how to do it. So, yeah, I completely gave up on it.

Reflected here are the low expectations of vegans towards PCPs, who are overwhelmingly expected to hold and display negative attitudes towards veganism. Encountering neutral or positive attitudes was, in this context, considered exceptional and a matter of good luck, with vegans readily evaluating such doctors positively.

Expectations of vegan parents in relation to PCPs

Overall, research participants expected PCPs and the healthcare system more broadly to accept and support veganism, including children’s veganism, drawing on contemporary scientific knowledge on plant-based diets and their health impacts, not based on personal bias. More specifically, the following expectations were voiced.

As a more immediate concern, vegan parents hoped that PCPs would stop automatically associating various health problems with veganism and rely on scientific information about plant-based eating instead of prejudice. They wished for PCPs to perceive (children’s) veganism not as a (potential) medical problem or health risk that parents expose their children to but as an ethically motivated way of life to be respected and supported (this aligns with the principles of patient-centred medicine, discussed in the next section):

Miina, 37, three children: I hope that the people who are currently studying to become doctors or are becoming doctors, that they have more of that sensitivity and understanding about this. . . [. . .] You can’t always blame veganism for everything. It’s not some kind of illness, it’s just like, I don’t know, it’s not even a diet — it’s more like a lifestyle or a principle. And that’s what I really wish for too, that there would be more doctors who don’t look at it so critically, but rather like — you live this way, and I understand this, and maybe, I don’t know, maybe it should be part of what’s taught in medical school or whatever, but in any case, you shouldn’t have to be afraid every time your child is taken to the hospital. . .

Adequate knowledge and advice on nutrition was expected from PCPs, which in the case of vegans would involve recommendations on how to follow a nutritionally balanced and adequate plant-based diet. As expressed in the following excerpt, some parents compared Estonia unfavourably to more progressive Nordic countries, such as Finland, in terms of the attitudes of the medical and nutrition establishment towards plant-based diets:

Jürgen, 36, two children: That in the medical system, family doctors would know enough — not that they’d have to heavily promote it [veganism] or anything — but when they find out that you’re vegan, they’d be like, “Aha, okay, got it,” and then take that into account. Like, if they see that you’re lacking a certain nutrient, they’d have the knowledge to know what the plant-based sources are. For example, if there’s an iron deficiency, they’d know what to recommend. And it’s not even just about the knowledge — that’s one thing — but also the attitude. I guess we’ve been kind of lucky ourselves, but I imagine that if we hadn’t been, it would be really harsh. Like, imagine a family doctor telling you, “You’re raising your children completely wrong, you’re putting them at risk.” [. . .] Like, how is it possible that it [veganism] is considered okay in the U.S., and then suddenly here it’s not? Or that it’s okay in Finland, and then you come across the sea and in Estonia it’s somehow not okay?

The two latter excerpts above address the fear of PCPs perceiving vegan parents of mistreating their children. The cultivation of PCPs’ increased knowledge and acceptance of veganism would help to eliminate fears of PCP-patient interactions where PCPs would potentially imply or explicitly accuse vegan parents of harming their children by raising them on a plant-based diet.

Some vegan parents framed the issue of how PCPs perceive and communicate with vegan parents as an issue of equal treatment, wishing that they would be treated just like any other patient, not associated with deviance:

Joanna, 40, one child: I just hope that it wouldn’t be a big deal — that it’s simply like, “Okay, you’re a vegan family,” and that’s it. I’m not expecting. . . I guess what I’d want most is just to be treated the same. I don’t want us to have to go through all sorts of extra testing, I don’t want us to have to justify why we’re vegan and all that stuff. I’d like them to treat us like regular people [laughs].

Although vegan parents were not always confident in their PCP’s knowledge about plant-based diets, they still expected them to contribute to maintaining and checking on their and their children’s health. Some participants hinted that they need their PCP to assure them that a plant-based diet is healthy and that they are not harming their children. This was represented in feelings of uncertainty and fear that parents experienced when the healthcare professional questioned their choices:

Miina, 37, three children: Well, maybe from the beginning it’s been about these vitamins, whether they’re getting all of them. We do eat this Vegan Society’s VEG1 [a vegan nutritional supplement developed by the UK Vegan Society] and all sorts of things. . . Then I’ve started to think about whether I should give calcium too. Because my oldest has broken his wrist twice in football. And he’s skinny too, and so on. Then I’ve started to think about whether I should give more calcium or whatever. Somehow, I kind of assume that if they’re like, they seem healthy, then they’re healthy, and then occasionally you have to do these blood tests, so. . . but. . . maybe yes, then if they. . .

One way participants sought reassurance about their children’s well-being on a plant-based diet was by requesting regular blood tests from their PCP. Participants believed that normal test results could help alleviate their own as well as their PCPs concerns as evidence that a plant-based diet can support healthy child development and does not warrant undue concern:

Vivian, 38, two children: The only thing is that I asked the doctor how often and whether we should do a blood test. So, let’s say, my family doctor is difficult about this, they don’t want to do any tests at all. I have to beg for these tests like I always do. I just begged for one at the end of last year, and everything was fine.

Such desire to subject children on plant-based diets to more frequent blood tests than omnivore children reflects how veganism – particularly in children – is constructed as contentious or deviant within the healthcare system. Despite the fact that blood tests cannot always adequately assess a patient’s health, for vegan parents, these tests serve not only to reassure themselves but also to provide evidence to potentially sceptical PCPs that a plant-based diet is suitable and healthy for their children.

Discussion and conclusions

This article has explored the experiences of vegan parents within the healthcare system, focusing on their interactions with PCPs concerning their children raised on plant-based diets, based on qualitative interviews with vegan parents based in Estonia. This focus addresses the role of the healthcare system more broadly and PCPs in particular in mitigating the current multiple and intertwined global ecological and health crises. Despite recent calls to treat human and planetary health as interconnected (Gibbs and Cappuccio, 2022; Springmann et al., 2016; Taylor, 2024; Willett et al., 2019; Rockström et al., 2025), the healthcare and nutrition establishment has largely remained disengaged – or only recently begun to acknowledge these links. This is reflected in the limited scholarly work on the topic and in the fact that most national nutrition guidelines continue to overlook these connections or have only very recently begun to consider them (see e.g. Springmann et al., 2020). The extent to which parents and families choosing plant-based diets are supported by the healthcare system can significantly influence the adoption of more sustainable lifestyles, including the broader transition to plant-based food systems.

Our findings indicate that vegan parents were uncertain and cautious about whether and how to talk to their PCPs about their family’s and, in particular, their children’s veganism, broadly aligning with the findings of some previous research in this aspect (Aavik, 2021; Bivi et al., 2021; Borisova et al., 2023; Jirovsky-Platter et al., 2024; Francis and Miele, 2025). Roughly half of the parents who participated in our study had informed their PCP about their child’s entirely plant-based diet, while the rest had not. Typical reasons for not disclosing their child’s veganism had to do with a fear of negative reactions and the assumption that the doctor’s potential bias against veganism would affect future interactions.

Some of those who had informed the doctor about their child’s plant-based diet did so gradually and carefully, trying to gauge the doctor’s attitude. A few disclosed the information strategically, believing it was necessary for diagnosing health issues and making treatment decisions. It was also thought to be important to raise awareness among PCPs about the existence of vegan patients (especially families and children), and that healthy vegans help dispel stereotypes associated with veganism and vegans.

Those who had informed their PCPs about their family’s diet experienced a range of responses, from sceptical and negative to neutral and, rarely, supportive. Some shared experiences where the PCP made inappropriate comments about veganism or recommended animal products for the child. These situations caused negative emotions in vegan parents and led in some to a desire to avoid visiting the family medicine centre – which can potentially result in undiagnosed health issues or other problems. In some cases, it was noted that the PCP admitted their lack of expertise in nutrition and either gave referrals or sought advice from qualified specialists.

The heterogeneous experiences of vegan parents in this study indicate that there is no standard procedure in the Estonian primary healthcare system on how to deal with vegan/plant-based families and the PCPs rely on diverse sources of information about (children’s) WFPB diets, reflecting similar findings from France (Barbier et al., 2024). In this context, the PCPs personal knowledge, experience and attitudes – including bias – towards plant-based diets and vegans becomes decisive.

The insights above suggest that in PCP-patient interactions, at least in contexts where there is considerable institutional prejudice, scepticism and even hostility towards veganism and vegans, such as in Estonia, vegans assume that PCPs likely regard their veganism as controversial or deviant (see Aavik, 2021, on how vegans are rendered as deviant in medical encounters), a dangerous practice or shameful secret, to be revealed hesitantly and gradually, that the PCP is likely to disapprove of, particularly in the case of children. For vegan parents who typically regard veganism as a positive core aspect of their family’s way of life that contributes to health, ethical and environmental goals, under the authoritative medical gaze of the healthcare system which regards plant-based diets with suspicion, veganism becomes transformed into something contentious. If vegans assume that PCPs hold such conceptualisations of veganism and plant-based diets, the extreme caution and hesitancy of vegan parents to disclose their children’s veganism to their PCPs becomes understandable, as the doctor might imply that they are harming their children – an extremely severe charge that vegan parents are at pains to avoid.

A key expectation voiced by the research participants was that PCPs demonstrate, if not a positive, then at least a neutral attitude towards their family’s decision to practice plant-based eating – grounded in established evidence rather than personal opinions. While this may seem like a modest expectation, it is understandable given the prejudice vegan patients have faced within healthcare systems in several countries (Aavik, 2021; Bivi et al., 2021; Borisova et al., 2023; Francis and Miele, 2025; Jirovsky-Platter et al., 2024).

These findings highlight the key importance of doctor-patient communication as an issue of patient safety (Beyer et al., 2009) in the context of vegan parenting/children’s plant-based diets. They also underscore the need for a more patient-centre healthcare where patient autonomy and values are respected, especially if these support goals of sustainability and public health (Evans, 2017; Nerenz et al., 2009). Historically, a paternalistic approach has been prevalent in medicine, assuming patients cannot make informed decisions (Schramme, 2015). In recent decades, this has shifted toward valuing patient autonomy – the right to make personal health decisions – leading to a broader adoption of person-centred care, which respects individual needs, preferences, and values (Evans, 2017; Institute of Medicine (US) Committee on Quality of Health Care in America, 2001)⁹. Effective implementation of this paradigm depends on healthcare professionals’ self-awareness and communication skills. Poor communication is linked to reduced adherence, worse chronic disease outcomes, and limited patient expression (Nerenz et al., 2009). However, these principles are still often overlooked in cases like plant-based diets, where patients’ choices continue to be disrespected.

The experiences of vegan parents in the healthcare system that we identified raise concern about the equal treatment of different patient groups within this institution. Our findings suggest that when PCPs are unsupportive of or hostile toward veganism, vegan parents are required to exert significantly more effort within the healthcare system compared to omnivore families – such as repeatedly justifying their lifestyle choices, and navigating bias or stigma. In this way, the healthcare system fails to support more sustainable or potentially healthier lifestyle choices and instead creates additional barriers for specific groups, particularly vegans with children. Emotions such as hesitation, fear, and discomfort are especially pronounced for vegan parents during interactions with PCPs. This internalised doubt is reflected in our finding that vegan parents often request frequent blood tests to reassure themselves that their children are not experiencing health issues potentially associated with plant-based diets. These feelings are often more intense than those experienced by child-free vegans or non-vegan parents, as healthcare professionals tend to approach children’s whole food plant-based (WFPB) diets in particular with scepticism and caution – due not only to personal bias but also to a lack of adequate information (Jakše et al., 2023). Vegan parents not only have to advocate for themselves but also carry the added burden of being held accountable for their children’s health, as PCPs are likely to perceive any potential health problem as associated with a plant-based diet.

These findings broadly align with existing literature on healthcare inequalities affecting marginalised and vulnerable populations – an approach often framed within inclusion health (see e.g., Luchenski et al., 2018). While we do not claim that vegans constitute a marginalised or vulnerable group in a broader societal or healthcare context, some of our findings suggest that the prejudice perceived by vegan patients in interactions with PCPs may echo the experiences of those groups. In particular, instances of stigma and inadequate support may compromise the quality of care they receive and potentially impact health outcomes.

The acceptance and support of WFPB diets and veganism for children by the healthcare system and medical professionals – based on scientific evidence about the health impacts of nutrition – requires changes to national dietary guidelines and increased awareness among healthcare workers about plant-based nutrition and its health effects, as well as the links between food production, consumption, and sustainable development. The healthcare system as an institution, along with key stakeholders such as PCPs, should be part of a systemic shift toward a more sustainable world, including a transition to a plant-based food system.

The findings and conclusions of this study have practical implications – for instance, they can inform the training and practice of PCPs. This study focused on the experiences of relatively privileged vegan parents within a single national context. Future research could explore the experiences of a more diverse group of vegan parents across different countries, including through comparative and longitudinal approaches. Another possible avenue for future research would be to focus on PCPs themselves, examining their views on patients’ (including children’s) veganism and WFPB diets, as well as understanding of their own and the broader healthcare system’s role in advancing sustainability and more ethical human-animal relations.

Footnotes

ORCID iDs

Kadri Aavik

Marta Velgan

Ethical consideration

The study was approved by Tallinn University’s Ethics Committee (22.09.2023, decision no. 21).

Consent to participate

Informed consent was obtained from all research participants prior to conducting interviews. Detailed information about the study was sent to them via email along with the invitation to participate in the study. Consenting to be interviewed after receiving this email constituted informed consent.

Consent for publication

Informed consent obtained from the participants included consent to publish the findings of the analysed data, provided that all participants remain anonymous. Participants gave consent for anonymised excerpts to be used from their interviews.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

Due to the sensitive nature of this research, data is not publicly available.

Notes

Author biographies

Kadri Aavik is an Associate Professor of Gender Studies at Tallinn University, Estonia. She works in critical animal studies, vegan sociology, gender and feminist studies and their intersections. Her recent publications include: Contesting Anthropocentric Masculinities: Lived Experiences of Vegan Men (Palgrave, 2023), Feminist Animal and Multispecies Studies: Critical Perspectives on Food and Eating (co-edited with Kuura Irni and Milla-Maria Joki) (Brill, 2024) and Routledge Handbook on Men, Masculinities and Organizations: Theories, Practices and Futures of Organizing (co-edited with Jeff Hearn, David Collinson and Anika Thym) (Routledge, 2024).

Marta Velgan works as a family physician in Estonia. She defended her PhD at the University of Tartu in 2025 and teaches medical students at the same university. In her research, Marta has explored the shortage of family physicians in Estonia. She uses mostly qualitative research methods.

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