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May 3, 2019

A Tale of Two Cheeseburgers

A Tale of Two Cheeseburgers

For the past few months, I have been fortunate to sit in as the dietitian for a meal support group at The Emily Program. In this group, clients of all eating disorder diagnoses and levels of recovery bring in their own meal to eat. During this shared meal, clients use the support of trained staff and other group members to work through and process their own food issues.

At a recent group, it just so happened two group members brought in cheeseburgers for their meal.

At check-in prior to the meal, one participant made the observation that she felt hungrier at this meal because the aroma of the cheeseburger she was bringing filled the car on her way over. Her goal was to eat mindfully and stop when she noticed she was feeling physical fullness. She found that this goal was challenged by her heightened “hunger” and desire to eat due to the exposure to the food aroma.

By chance, the person sitting next to her also brought a cheeseburger. However, their struggle was an entirely different one. Though this client had enjoyed cheeseburgers prior to their eating disorder, they found that it had become a feared food during their eating disorder. Therefore, bringing a cheeseburger in to eat was a challenge they set for themselves. This situation was made unexpectedly more difficult because it turned out that it exceeded their meal plan by one exchange. This significantly raised eating disorder thoughts and judgments around the perceived danger of going over their allotted exchanges.  

These cheeseburgers were the same food item—same ingredients, same preparation, same appearance—but they elicited two totally different reactions. In both cases, the individual’s eating disorders had gotten intertwined with what eating that cheeseburger represented – for one it might be pleasure, excitement, or security. For the other, possibly discomfort, dread or danger? Interestingly, for both, it perhaps represented an overlapping fear of loss of control and a possible sign that they were failing in their recovery efforts.

By the time the meal ended, one client had eaten a portion of their cheeseburger and stopped, leaving the rest, while the other had eaten  100% of the cheeseburger.

Does it matter which client had which outcome? Was it better to finish the whole burger or to leave some? Absolutely not, neither option was better…. the only reason one outcome would be preferable to another is if it supported and reinforced that client’s ability to decide that they had the power and ability to choose to stop eating or continue eating, not their eating disorder.

Because in the end, it was never really about the cheeseburger….


Hilmar Wagner headshot

Hilmar Wagner, MPH, RDN, LN, CD

Hilmar Wagner (he/him), MPH, RDN, LN, CD, is a Clinical Outreach Specialist for Accanto Health, the parent company of The Emily Program and Gather Behavioral Health. In this role, Hilmar has presented on a wide range of eating disorder topics and related nutrition topics at local, regional, and national conferences. In addition to his deep understanding of evidence-based eating disorder care, he has a particular interest in the application of mindfulness and body-centered, somatic approaches to the nutritional treatment of eating disorders.

Hilmar received his bachelor’s degree in Nutrition/Dietetics and master’s in Public Health Nutrition from the University of Minnesota. Prior to joining The Emily Program in 2006, Hilmar worked as a Registered Dietitian in a variety of clinical, outpatient, community, and supervisory settings. In his over 15 years of experience, Hilmar has worked directly with clients of all eating disorder diagnoses in a variety of clinical settings. He has also served in management roles at the site, regional, and organization-wide levels.

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