Why Being Perfect Isn’t a Requirement for Diabetes Care

What if the real barrier in diabetes care isn’t noncompliance but the quiet expectation of perfection? How might care shift if we stopped measuring success by flawless outcomes and started centering

What if the problem isn’t that your clients aren't doing enough but that they believe they have to manage their diabetes perfectly?

This belief that only perfect adherence, perfect numbers, or perfect bodies count as success quietly distorts diabetes care. It pushes clients toward shame and away from self-trust. And it pushes professionals toward rigidity, burnout, and bias, all in the name of standards.

Perfectionism is not simply a personality quirk. In healthcare, it's a structural value: rewarded, reinforced, and rarely questioned. It reflects a deeper fallacy that assumes if a person just tries hard enough, they can, and should, achieve flawless control of their diet, blood glucose, and body. This fallacy erases the complexity of living with diabetes. It upholds diet culture and fear-based motivation. And it narrows our vision of what care can be.

How Perfectionism Shapes the DIabetes Space

Clients often come in already primed to feel inadequate. Many have internalized the belief that anything less than “100 percent compliance” means failure. It sounds like:

• “If I can’t do this perfectly, why bother?”

• “I was doing so well, and then I ruined it.”

• “My numbers are all over the place, and I’m embarrassed to show you.”

This isn’t just self-criticism; it’s the residue of a system that values control over curiosity. Diet culture thrives on this mindset. It teaches that health is a moral pursuit, one that hinges on restriction, control, and visible transformation. When clients feel ashamed of their bodies or their lab values, it's not because they're fragile. It's because perfectionism has been presented as the only path to approval, safety, or even basic respect.

The Clinical Implications of the Perfectionism Fallacy

As clinicians, we’re not immune to this thinking either. It’s easy to fall into binary frames: compliant/non-compliant, motivated/unmotivated, adherent/nonadherent. These frames simplify complex lives into data points. They make it harder to recognize trauma, food insecurity, systemic bias, or the daily toll of stigma.

When we expect perfection, we unintentionally shift responsibility for health outcomes entirely onto the individual. That’s not care—it’s surveillance. It’s the kind of thinking that leads to:

• Overemphasis on weight and weight loss as proof of success

• Clinical inertia when patients “fail” to meet targets

• Loss of rapport due to shame-based counseling

• Professional burnout from chasing metrics instead of meaning

Inclusive care challenges these assumptions. As I explored in the article, Living in a Culture of Stigma, stigma is not just a feeling, it’s a public health issue.

The American Diabetes Association just released its Standards of Care about Diabetes and Weight Stigma. The larger diabetes community is recognizing the impact of stigma on care because the push to be perfect shapes access to care, quality of care, and health outcomes.

Perfectionism is one of its most socially acceptable disguises, and
diet culture is often how it hides in plain sight.

Rethinking Standards, Not Lowering Them

Letting go of perfectionistic thinking doesn’t mean settling for less. It means acknowledging the gap between what guidelines prescribe and what life permits. Evidence-based care doesn’t require perfection. It needs context, flexibility, and relationships. All diabetes guidelines are tailored to the individual client. Diabetes care isn’t one-size-fits-all!

Ask yourself:

• Am I interpreting standards of care as expectations for perfection? If I am, is my fear driving this desire to be ‘perfect’ or ‘right’?

• Am I fully listening to my client if I rely on ideal-world assumptions instead of real-world support?

• How often do I center weight, compliance, or glucose targets at the expense of dignity, autonomy, or mental health?

When we treat the standards as absolutes, we leave no room for progress. This means that we are sorting diabetes by a pass/fail standard, which lands as judgment. That’s not how humans grow. That’s not how change is sustained.

Building Better Care Together

I recently published the Road Map for Weight-Inclusive Diabetes Care on the No Weight Loss Required Substack. (This is a client-facing newsletter) I invite you to rethink our role: not as enforcers of perfection or parrots repeating unreasonable guidelines to our clients. Instead, let us see ourselves as partners in possibility, and that means stepping into the many imperfect aspects of diabetes care with grace and humility. This shift is especially urgent in the face of rising stigma, burnout, and inequity in diabetes care.

It begins with recognizing how perfectionism and diet culture have become internalized messages. To help clients, I explain the IIRR approach, and yes, you can say it like a pirate!

• Identify diet culture

• Interrupt diet culture

• Reduce weight stigma

• Repair the harm caused by experiencing weight stigma

Here's how you can use the IIRR approach with clients

Help clients identify how diet culture disguises itself in language that promotes wellness. Common red flags include:

• Many "Lifestyle changes" are actually restrictive diets in disguise.

• Programs that promise "health" but only focus on weight loss.

• Fear-based messaging about food, such as "toxins" or "bad ingredients."

Support clients as they interrupt diet culture. This might be when they:

• Decline being weighed

• Create personal boundaries surrounding food, weight, and diet-related conversations. “I don’t want to talk about dieting.” “Weight loss is not the goal of diabetes care.” or “Weight is not the sole measure of my health.”

• Choose to read, learn from, and share stories from fat individuals challenging diet culture, weight stigma, and seeking sustainable self-care instead of books and information from “credentialed” professionals.

Affirm a client’s decision to reduce weight stigma. This might be when they:

• Talking to you about not being weighed or discussing weight loss at a visit.

• Explain that they don’t consume media (TV, social media, books, podcasts) that promote restrictive eating and weight loss or suggest that weight loss is desired or healthy.

• Need support to use a weight-inclusive approach to prevent or manage blood glucose.

Create spaces that help clients repair the harm caused by experiencing weight stigma. This might be when they:

• Ask for or insist on being in spaces that they feel safe in.

• See opportunities to exercise their agency (smart and able) and autonomy (have choices beyond weight-focused interventions).

Let’s stop expecting perfection in diabetes care because it’s likely diet culture in disguise.

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Megrette Fletcher, M.Ed, RDN, CDCES, is a weight-inclusive diabetes care and education specialist and dietitian. She sees clients individually and is accepted by most insurance companies in 29 states.