Episode 69. National Eating Disorders Awareness Week

Eating Disorders Awareness Week is underway and today’s show is our commitment to supporting the incredible work being done to raise awareness on the impact disordered eating can have, both for our ADHD community and society as a whole.

I’ll just be upfront here, this episode does not focus entirely on ADHD and eating disorders. Instead, our team made the decision to look at how eating disorders impact our society as a whole and what’s being done to improve how we diagnosis and treat eating disorders. It’s estimated that 9% of the world’s population has an eating disorder and it is also one of the deadliest mental illnesses, making Eating Disorders Awareness Week something we needed to support. 

Joining us on the show is registered dietician nutritionist Hilmar Wagner from The Emily Program, a nationally-recognized program focused on using personalized treatment plans to help patients find lifetime recovery from their eating disorders. Hilmar works with both patients and providers through his role at The Emily Program and we’re diving into the big picture impact of eating disorders, what’s changed over the years when it comes to diagnosing and treating eating disorders and also looking at the state of care for people seeking treatment for an eating disorder.

Eating Disorder Resources

If you or someone you know is struggling with an eating disorder, call the National Eating Disorder Association Helpline at 1-800-931-2237. 

It is a toll-free, confidential number you can call Monday through Thursday from 9:00 a.m.- 9:00 p.m. Eastern and Friday from 9:00 a.m. – 5:00 p.m. Eastern.

More information on the NEDA Helpline


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Lindsay Guentzel (00:12):

On today’s episode of Refocused, we are talking about eating disorders. If you or someone you know is struggling with an eating disorder, there’s a long list of resources to help, including the National Eating Disorder Association helpline, which is a toll free confidential number you can call Monday through Thursday from 9:00 AM to 9:00 PM Eastern, and Friday from 9:00 AM to 5:00 PM Eastern. That’s at 1(800) 931-2237. Again, that’s 1(800) 931-2237. We’ve included more information on the helpline, as well as more resources for you to check out in the show notes.


Welcome back to Refocused, a podcast all about attention deficit hyperactivity disorder. I am your host, Lindsay Guentzel. And on today’s episode, we are going to talk about eating disorders. Back in January, we dove into our relationships with food, first by talking about the connection between ADHD and disordered eating with Dr. Marilyn James, and then we explored ways we can make food less of a battle in our daily lives with registered dietician nutritionist, Becca King. Those are episodes 61 and 62 if you haven’t had a chance to listen to them yet. So what are we talking about today? Well, this week, February 27th through March 5th is Eating Disorders Awareness Week. It’s an annual campaign that works to educate the public about eating disorders. What are they really like? How they impact not only the individuals dealing with them, but the people around them as well, their friends, family, colleagues, even children.


The goal of this week is to provide hope, support, and visibility for those affected by eating disorders. Because if you are one of the hundreds of millions of human beings who have found themselves battling an eating disorder, you know how consuming and overwhelming it can be. And yes, I said hundreds of millions of humans. It’s estimated that around 9% of the world’s population has an eating disorder. That’s according to the National Association of Anorexia Nervosa and Associated Disorders, which estimates that more than 28 million Americans will have an eating disorder in their lifetime. And just like ADHD, genetics can play a role. I’m just going to be upfront here. This episode is not going to focus on ADHD and eating disorders. While it’s obviously the main topic we cover here on Refocused, I also like to think of this space, this podcast as a place to talk about our mental health, and disordered eating fits right into that.


Here’s a sobering statistic for anyone who has ever thought eating disorders aren’t that big of a deal. Eating disorders are among the deadliest mental illnesses, second only to opioid overdose, and 10,200 deaths each year are the direct result of an eating disorder. That’s one death every 52 minutes. So what can we do for ourselves, yes, but for our loved ones, our friends, our communities, our future? What do we need to understand better? Joining me today is Hilmar Wagner, a registered dietician nutritionist who is a licensed nutritionist in Minnesota, as well as a certified dietician in the state of Washington, who currently shares his expertise by supporting the team at The Emily Program, a national leader in eating disorder awareness, treatment, and lifetime recovery, offering personalized treatment for eating disorders. They were founded back in 1993, and they currently operate sites in four states, including Ohio, Pennsylvania, Washington, and Minnesota, which is how I am familiar with the work that The Emily Program does.


Years ago, before the pandemic, and before my ADHD diagnosis, I went through the admissions process to seek help from my disordered eating before hitting that lovely insurance coverage snag. But my experience there, while short, made me very confident they were the right choice for this conversation. And I’m so grateful to Hilmar for joining us today. Hilmar, welcome to Refocused.

Hilmar Wagner (04:33):

Lindsay, so happy to be here with you.

Lindsay Guentzel (04:35):

Let’s start by talking about the work you are doing at The Emily Program, because in reading through your bio, I get the idea that you wear many different hats.

Hilmar Wagner (04:45):

I appreciate that. Two major ones actually. So I’ve been with The Emily Program and working in eating disorders for just a little over 15 years now. And over that period of time, the majority of that time has been spent in direct client care, so working individually with clients with eating disorders, in groups, et cetera. And then in the past five years or so, I’ve transitioned into doing clinical education outreach, so speaking to groups in the communities, therapists, dieticians, medical providers, or giving seminars, participating in organizations that specialize in eating disorders as well. So that’s one of the two hats. And the other one, I have the pleasure of working with the University of Minnesota’s dietetic internship program to help coordinate the eating disorder concentration, which they offer as one of two concentrations that the university offers. And until a couple of years ago, it was the only dietetic internship in the country with a specialization, a concentration in eating disorder. So we’ve been very fortunate to be able to help train our young and upcoming dieticians in the care and treatment of individuals with eating disorders.

Lindsay Guentzel (06:07):

I’m really glad you touched on that, this idea that up until a few years ago, this program at the University of Minnesota was the only one. And the connection I can bring back to ADHD is I think sometimes we think we have it all figured out. We’ve known about eating disorders for a long time. We’ve known about ADHD for a long time. That long time in the grand scheme of what we’ve figured out is tiny, it’s minute, and it’s so important to really recognize where we are right now is an improvement, but we have so much more work to do.

Hilmar Wagner (06:41):

That’s so true. The whole area of research in eating disorders is, in the general timeline of medical scientific research, really brief. And interestingly and not in a great way, it wasn’t until, and again, somewhat fairly recently, that there was any research studies that included males. It was an exception, because men don’t have eating disorders. I would say that it hasn’t been that long, but we’ve made tremendous strides in that period of time to now have a really good understanding that eating disorders are biologically based, brain-based, biologically driven eating disorders. They’re mental health disorder, but we’re starting to understand more and more about how the neurobiology of individuals make them more susceptible to the risk of eating disorders.

Lindsay Guentzel (07:39):

I’m glad you touched on that. The biopsychosocial model of eating disorders. May have practiced it a few times, and I still butchered it. The biopsychosocial model of eating disorders. And like many things in life, talking about eating disorders can feel very daunting because they’re just so much. And if you peel everything back, we get to this biopsychosocial model of eating disorders. And you said biologically, eating disorders are based in the brain. They’re a brain illness that’s influenced by environmental and psychological factors. So what does that model tell us about eating disorders?

Hilmar Wagner (08:16):

A few things. One, the incredible complexity, it wasn’t that long ago where we were able to study the whole human genome, and it became very clear upfront that there wasn’t going to be the gene. We weren’t going to find the gene that causes eating disorders, that it’s multifactorial and really complex. And if our listeners can maybe imagine this Venn diagram with three larger overlapping circles, with one small circle right in the middle that contains a piece of all of those circles. And what it helps to illustrate is that there are tendencies, biological, neurobiological tendencies towards eating disorders, but those are influenced and oftentimes are the cause for the trigger that takes that otherwise latent tendency towards eating disorders and brings it to the forefront. And so those risk factors can be in the biological section. As we know, we are all generally the same on the inside, just like we’re generally the same on the outside, but some of us process food differently.


Some of us have a greater drive for food. And that has been an evolutionary advantage. But now that most of us are surrounded by 24/7 opportunity for food, that biological drive to find and consume foods, especially those foods that are in higher energy density or that are sweeter, have what kept mankind alive for so long, but now can add certain stressors. So there’s other biological risk factors, but then they’re also psychological. We’re learning more and more about the certain traits and temperaments that individuals have that can predispose them to greater risk for eating disorders. Certainly and tragically, it’s very common that individuals have a history of trauma, sometimes currently dealing with trauma, and so that psychological emotional component.


And then the third circle is cultural. And I know you’ve spoken on this at length and other episodes, but it is our demented focus on the unrealistic thin ideal, especially for females, but increasingly for males, and not just males or females, but all genders and all sexual identities as well. So that drive to meet certain cultural images and ideals is a very strong factor. And buried in that is the enormous number of people that are engaged in weight loss dieting, not necessarily for health, but to focus on trying to achieve that ideal or trying to relieve themselves from the social stigmas and weight bias and bullying that comes for individuals that live in bodies that are not deemed to be how they should be.

Lindsay Guentzel (11:34):

I have this model in front of me, and I’m just going to run through the different bullet points. So we’re talking the biological influences, we’re talking dieting and food exposure, genetics, and epigenetics, if I said that correctly, someone without a science background. We’ve got neurochemistry, and included in that is serotonin, dopamine, opioid and gaba. There’s the neurobiology, the temperament and traits. And then puberty and menopause as a woman. My goodness, it’s just you get through one, you get a few years break, and then you go right into the other. Then we’re talking experience, psychological factors. There’s the stressors and coping, identity and self-image, trauma, anxiety and depression, substance use. And then finally that environmental factors, weight and appearance pressures, media messages, weight comments and teasing. When we talk about this model, is there one specific item that stands out for you as the one that maybe we’re not paying close enough attention to?

Hilmar Wagner (12:36):

Because there are such variety in eating disorder diagnoses, it’s going to be an easier question to ask, and it may help us to narrow in our scope of discussion today on maybe one or a couple specific eating disorders. There’s not enough attention paid to, or not enough research into the overlap between binge eating disorder and ADHD. In a broader context, within those two disorders, it’s the misunderstanding of the severity and prevalence of binge eating disorder. It is by far the most prevalent eating disorder, and people have no idea. There is more binge eating disorder than there is than anorexia and bulimia combined, and yet we don’t see nearly the same level of outreach, public awareness, mental health and physical health providers awareness and seeking out assessment, referral to treatment, or the ability for these individuals to access treatment. It’s a struggle for people with all eating disorders, but for an individual with binge eating disorder, there are additional barriers.


And unfortunately, some of those barriers are couched in our societal implicit and overt prejudice because most of the individuals that we see that present for treatment with binge eating disorders also live in larger bodies, not all. And it doesn’t mean that you can’t live in a straight size body or any size body and not have a binge eating disorder diagnosis, but many do and they face those additional hurdles.

Lindsay Guentzel (14:30):

I can go back to when I first learned about eating disorders, which is probably middle school, we’re talking late nineties, and it was anorexia, bulimia, and there was this tiny conversation just starting around binge eating. And most of the time it was binge eating and purging together. Where do things stand right now with actual diagnoses within the eating disorder spectrum?

Hilmar Wagner (14:55):

Yes, it is good to have an update on that. Anorexia and bulimia, there’s been updates to those over time. One of the most significant for the diagnosis of anorexia is the removal of the criteria for recovery from anorexia being resumption of menses. There are still these echoes of female focused criteria, even still in the assessment tools. The questions are oftentimes presented in a way that would be more likely directed to someone that was born female versus born male, or identifies as female, than identifies as male. So there’s been updates. And in 2013 was the most recent revision of the Diagnostic and Statistical Manual, the DSM, and that is the mental health Bible, right? So this says what is in is not a diagnosis.


So 2013, 10 years ago now, binge eating disorder became its own established disorder. It had been in a category called eating disorders otherwise not specified. So there was enough research and understanding to be able to create diagnostic criteria, and that has been the largest addition, and one that even though it has been 10 years, it has not, as I guess I’ve said, received the attention that it needs to match the prevalence.

Lindsay Guentzel (16:33):

I’ve mentioned that you’ve been with the EMILY program since 2006, and I imagine that means that you’ve seen quite a few changes, both in how we identify eating disorders, and then in the treatment. What stands out to you as some of the biggest things that you have found to be most notable during that time?

Hilmar Wagner (16:49):

There are several. One has been the establishment of the diagnosis for eating disorders. When I first came on at The Emily Program, the very first group that I was working with were individuals that struggle with what is now diagnosable as binge eating disorder, and yet there wasn’t an official diagnosis. So we referred to that group as individuals that had compulsive overeating or binging, but they didn’t have a specific diagnosis. So there’s been huge advances there, not only in the identification, but our ability to find more and more effective treatments. So that is one in the area of binge eating disorder. The other has been the focus in recent years on research that involves brain scans, functional MRIs where we are really starting to be able to see the way that the brain responds to certain stimuli and has enabled us to not only help our clients have a better understanding and realize that it’s not their fault, they’re not something they’re doing on purpose, but there are these drivers that have put them in a place of having a greater risk factor or are propagating their disordered eating behaviors.


The other advancement has been on this work that has been done by Dr. Laura Hill, looking at temperament traits. And I’ve heard you speak to some of this in other episodes as well, where an individual that might have temperament traits… There are no bad temperament traits. We just all have different traits. They’re baked in part of us. So the temperament trait might be one of excitability and inquisitiveness and risk tolerance, and it makes individuals very creative and fun to be around, but those same sort of traits can get hijacked by the individuals eating disorder and take over in a way that may drive them deeper into their eating disorders. So to help the client, the loved ones, the support group, understand that this is part of what it is that they’re dealing with and how we can use those same wonderful traits and redirect them for good and to help them in their recovery efforts as well.

Lindsay Guentzel (19:30):

You touched a little on ADHD, and I’m wondering if we can sit in this little pocket for a second because there’s a lot of comorbidities that are tied with ADHD, and I am wondering if that is a similar scenario with disordered eating. And sometimes it feels like when you are on a journey to figure out what’s going on with your brain and your body, it’s trying to figure out the chicken or the egg conundrum, what starts it, what’s exasperating it, and sometimes I don’t know that you ever figure that out. So when we talk about eating disorders in the comorbidities that can be tied to them, what do we know and what can we be looking for?

Hilmar Wagner (20:11):

You’re exactly correct that individuals that have an eating disorder very likely have one or more comorbid mental health diagnoses, anxiety, depression, OCD, ADD, ADHD, bipolar disorder. 80% are likely to have at least one comorbidity, and 50%, two or three. So it gets to be a very complex picture, which I think is what you were speaking to. And if we’re looking specifically at ADHD, and I’ve been thinking a little bit about this in preparation for our discussion, as we go back to that biocycle social model, I see ADHD as a potential risk factor for an individual that could predispose them to disturbances in their eating patterns. I know you’ve spoken of your own journey in that. And so that could be one of the areas that might lead that person down a path to disordered eating for all the sorts of reasons that your other guests have mentioned, more difficulty in planning ahead, shopping, prepping, preparing, remembering, but the diagnosis of ADHD would not lead a person independently to a diagnosis of eating disorders.


I can’t imagine, at least that would be the case. If we think about that Venn diagram with that little circle in the middle, which is eating disorders, there are almost always multiple factors, but that could be one. And let’s say that person has also had failure to thrive as an infant or adverse childhood experiences, a divorce, a death of a sibling or parent. That could be that stressor that changes it from a latent tendency… Epigenetics is just a fancy word for turning on that gene that otherwise may lie dormant in the background. So if there are a host of other factors that the ADHD could be the thing that might open the door, but there would be other drivers that would end up bringing that person to treatment for an eating disorder.

Lindsay Guentzel (22:41):

The perfect segue. And we’ve touched a little on this idea of spectrum. And that with spectrum, it allows for ebbs and flows, and there can be just a ton of different outside factors that can impact that. And I’m hoping if we can focus on this middle ground for a second, because it seems from my experience, those people who tend to find themselves in the middle ground are the ones who often get overlooked. Whatever they’re dealing with, it doesn’t check off enough boxes to make that… It’s so impactful on their lives that they either pursue help or, and I would be curious to know your thoughts on this, they haven’t connected the dots yet. They’re living this life, and they think that what they are going through is what everyone else is going through. And it hasn’t gotten to the point where they’re like, “Oh, you mean I don’t have to be living this way?”


And I think sometimes with people who fall into that little middle area with disordered eating, they’ve accepted that’s the relationship they’re going to have with food and the relationship they’re going to have with their bodies, and that it’s “normal.” This is something I think a lot of people with undiagnosed ADHD have dealt with, not quite finding the space where they fit in. Would love to hear your thoughts on how the providers are addressing this and how we are changing the way we’re talking about awareness to fit in these people who fall in the middle who can use help and who can benefit from help, but for some reason haven’t made it to that point yet.

Hilmar Wagner (24:06):

Yes, it’s such an excellent point because it’s really muddy. For those people who are maybe struggling with some disordered eating, it isn’t always that apparent even to providers because our society endorses all of these ways of eating that look pretty disordered and pretty extreme, and that has been just herbo charged over the pandemic where there is this hyperfocus on food, eating, appearance. We oftentimes use the term orthorexia. Mistakenly, it’s not a eating disorder diagnosis, but it does a really nice job at capturing that idea of the individual that is really focused on food and eating, and oftentimes uses that as a means to the end to control, manage, or recover from a medical diagnosis or a mental health diagnosis, or for comfort, identity, control. And it wouldn’t necessarily meet criteria for a full eating disorder diagnosis, but it doesn’t mean that is not going to lead that person deeper and deeper into a use of behaviors and symptoms that could put them in a very dangerous place.


So part of it is both driven by cultural societal messages that we receive. It is so around us so much that sometimes it feels like it falls into the background until it becomes something that the person is striving towards. And then all of those messages feel like it supports those changes. And again, if there’s those underlying risk factors and that one or more very stressful situations, that could be the turning point for that person. So those individuals in the middle very often do get overlooked because it feels like the effort is to eat better or to take better care of their bodies, and that is highlighted to the most extreme degree for individuals that might have under underlying binge eating disorder that live in larger bodies because there’s all of these automatic assumptions that are made.


And one of the conditions that we’re seeing more and more is atypical anorexia, and that is one where the individual meets all the criteria for anorexia, which can be very severe and debilitating both from a mental health and physical health standpoint, that can include and lead to death. The only “atypical” part of it is the person with that diagnosis may live in a straight size body or be higher weighted. And because of that, they oftentimes go misdiagnosed sometimes with binge eating disorder or undiagnosed. And all of the messages they receive from society, and oftentimes medical professionals, is “Wow, you are doing such a great job. Look, you’re losing weight,” without asking the underlying questions about, what is going on for you? What’s happening? How is it that these changes are occurring? And it could be because they are engaging in prolonged starvation or fasting or the abuse of laxative diuretics, or purging, vomiting, things like that because there just is not the awareness that is a condition that is every bit as serious as the diagnosis of anorexia.

Lindsay Guentzel (27:57):

I think we fall into this habit of connecting eating disorders with women because that’s the predominant group that tends to seek help for it, but it’s important to talk about in this gray area, men, but then also people who are non-binary, gender fluid. And I’m curious how you start to change kind of that narrative for these groups that are being affected by eating disorders but aren’t showing up at the top of the list.

Hilmar Wagner (28:27):

We oftentimes hear the statistics about the prevalence, and it’s majority female and the incident isn’t as high in males. I don’t think that incidents isn’t that high. I just don’t think we’re looking, and looking to assess and treat. And there is, to your point, still this impression that if I identify as male and I have issues around my food, eating, body appearance that I can’t have an eating disorder, because that is younger, white, upper socioeconomic females. And that can’t be further from the truth. So we have to do a much better job at getting the word out that eating disorders affect everybody, all genders, all ethnicities, all racial and sexual minorities. And in fact, what little research has been done shows that in sexual minority populations that the percentage of those individuals eating disorders is higher than in the majority population, and yet there is very little awareness of that, and the investigation or the assessment is going largely unnoticed.


If you just step back and think about it for a minute, if it is a combination of risk factors and stressors, if I’m in a sexual minority or ethnic minority population, I will be subjected to many more stressors, and it’s that difficult, sometimes deadly, combination that drives people into disordered eating behaviors, and then ultimately into an eating disorder.

Lindsay Guentzel (30:07):

I’m glad you touched on sexual minorities, but then also minorities in general because there are statistics that show that people of color are less likely to even be talked to about eating disorders, and I’m wondering how we work to break down some of those stereotypes. And obviously there’s so much privilege that plays into that, and having access to proper healthcare, having access to people who are asking the right questions. What’s being done right now that you see is working to change some of the stereotypes that have been holding us back?

Hilmar Wagner (30:43):

There’s a number of things. You had referenced, NETA, the National Eating Disorders Association, and they’re doing a very concerted effort to put the word out to have greater awareness of the impact of eating disorders on populations that are underrepresented. It is also tied to the body acceptance, weight neutrality movement because there are oftentimes so many interconnections. There’s a number of groups now that are really helping to bring forward the awareness that weight stigma and eating disorders have a racial roots to that as well. Lastly, we have heard from individuals that have sought treatment the providers are not reflected in the same way that they are. So there’s a concentrated effort within the field to try and increase the diversity of providers as well.

Lindsay Guentzel (31:46):

We’re seeing that as well in the ADHD community, and it is important, especially when you’re talking about groups who have been pushed aside and have trust issues within the healthcare system, and rightfully so. The power of speaking to someone who you feel comfortable with cannot be stressed enough.

Hilmar Wagner (32:06):

I couldn’t agree more. For those individuals that do seek treatment for binge eating disorder, as I had mentioned, they’re oftentimes do present in a larger body of any gender or ethnicity. They may find themselves in a treatment group for which they do not see others that look like they struggle in the same way. There are programs that are single diagnoses. So a program would be specifically for binge eating disorder where those individuals feel it’s easier to feel a sense of community and understanding than in a trans diagnostic or a mixed diagnostic group. There are advantages. In the end, the drivers for the eating disorders end up being more common than difference. The expression is anorexia or binge eating disorder, but the underlying drivers may be very similar based on increasingly other traits and temperaments and biological factors that it is expressed indifferent eating disorders.

Lindsay Guentzel (33:14):

I want to take us back for just a second to sophomore year of high school. I was working on a social studies project where we had to pick a topic, something that we could see was currently affecting society, and my group chose eating disorders. And at the time, keep in mind, this is like 2002, the internet was just a baby, and still back then, so much of our project focused on these pro-eating disorder communities, entire blogs and message boards with thousands of engaged followers who were promoting these types of lifestyles. And is it possible to quantify the role that the internet has played in increasing the prevalence of eating disorders, or will we never know?

Hilmar Wagner (33:56):

There are a good number of studies that have looked at the impact of social media, and it is, in general numbers, high. The difficulty is that there are all sorts of criteria for that study. And to bring us back to a few minutes ago, who is looked at in those studies still tends to not really reflect the full experience as well. What we can see is that the unfortunate occurrence of the pandemic, there is very good studies to show that the incidents of eating disorders rose dramatically, and that the consumption of social media increased dramatically, and there is not just coincidence, but some causality showing that the individuals with the greatest intake of social media are at the highest risk for eating disorders. So it is strong and is growing.

Lindsay Guentzel (35:01):

A statistic for you on the COVI- 19 pandemic, the NETA Helpline, which is the National Eating Disorders Association tool-free confidential helpline, they saw a 107% increase in contacts since the start of the COVID-19 pandemic. And what you touched on makes total sense. We were at home, we had little to do, we have our phones in our hands, we’re trying to buy time, and we were told it’s going to be a couple weeks and it turned into years. So people are digesting things in a rate they hadn’t yet before.

Hilmar Wagner (35:39):

I would like to also just add one thing from your description that made the effects of the pandemic even more devastating for people with eating disorders, because it’s hard to even remember now, but the fear was around food. The shortage was around food. Even to go and get food was a risk that you might get sick and die. Oh my God, I hope you also got your groceries and did the sanitary wipes and cleaned them all off, and then washed our hands. We just didn’t know. And so the pressure, especially for individuals that were struggling with eating disorders, was just through the breath.

Lindsay Guentzel (36:25):

I had not thought about that connection to it. But when you are talking about people who have disordered eating, of course that makes sense. Of course, this sudden change in our routines and how we are getting food and finding food and feeling comfortable around food, of course that changes

Hilmar Wagner (36:42):

Anxiety, of course, depression. But it just because it involved food, it was so devastating for people with eating disorders.

Lindsay Guentzel (36:53):

I asked this question at the beginning, and it’s a loaded one, what can we do? But before we dive into kind of looking at the individual person, I’m wondering if we can start by talking about that as a society as a whole.

Hilmar Wagner (37:05):

The ways that society as a whole plays into the risk factors for eating disorders cannot be overstated. And there are some glimpses of progress, but there are also some ways those risk factors are getting entrenched as well. So within those social cultural factors, I had mentioned the drive for thinness, the unrealistic thin ideal, there is some movement to counter that and less focus, more size diversity in our media, but there is also a consistent and increasing focus on food and eating, the absolute right thing to eat, or you should never eat this, the idea that there are good foods and bad foods, and that there is some sort of moral or personal attachment to that. If I eat carrots, I’m good. If I eat carrot cake, I’m bad. And that tends to continue to be propagated through a society. I am a card carrying dietician.


There are some within my profession that would propagate that. It is important that a individual that’s struggling with eating disorders needs to see somebody that specializes in eating disorders, just like they do with ADHD. The episode with Becca King was so informative in that regard. It is around appearance, it is around food, and it is about the idea of striving and perfectionism, and that brings out that drive to achieve a certain end at any cost that can be very triggering for individuals that have those personality traits, but then are subjected to all of this other distorted information.

Lindsay Guentzel (39:02):

And then of course, we have to talk about the individual person, which I know is a very gray area, because what works for you might not work for me and vice versa. But is there a safe starting point to send people if they want to spend some time exploring their relationship with food and their bodies?

Hilmar Wagner (39:20):

From the most general, there would be the both sort of introspection or discussion with a trusted loved one or family member or friend, to just discuss, is there ways that my food or eating choices, habits are negatively affecting other areas of my life? Hallmarks of disordered eating and eating disorder almost always include a sense of rigidity and constriction. So in my pursuit of eating in a certain way or looking to alter weight, shape, size, health, am I doing so in a way that is negatively affecting me in other areas of my life, in my relationships, in my overall health wellbeing, in my sleep, in my sense of joy and purpose in my life? There are a number of books, websites, podcasts that can be helpful in that exploration. It can also certainly be done within discussions with a professional, a dietician, a medical professional, a mental health professional.


But again, I can’t underscore enough, that person would need to have a background and understanding of eating disorders just because they may inadvertently further that person’s drive to an area that may not be apparent. That is not going to end up well for that person.

Lindsay Guentzel (40:57):

I want to wrap up by asking you a question that I’ve asked a few guests in the past. What gives you hope right now? What is it about the work that you’re doing that is pulling you along, that keeps you showing up?

Hilmar Wagner (41:12):

It is a combination of things. There’s increasing effectiveness in our recovery approaches, and we see more and more people achieving full recovery in shorter and shorter periods of time. It is still a long and involved process, but we are seeing people seek out treatment earlier and better courses of treatment. That real life experience of being able to support and work alongside a person in their recovery efforts. And to see them come back online, regain their life, regain their ability to have true choice, I can now decide how I want to feed my body, look at my body, interact with my body and not be in the clutches of the disordered judgments and assumptions that are made within the eating disorder. And the other is that through efforts, such as ours and others, that there is greater awareness, and more and more people are able to understand that there is help and that there are ways that they also can free themselves of these disordered thoughts, actions, and behaviors that are having such a diminishing effect on their lives.

Lindsay Guentzel (42:31):

I have not heard the phrase true choice before, but I will be writing that one down on a few different post-its to put around the house. Because if that didn’t just encapsulate exactly what we all want in life, regardless of what we’re dealing with, to have the true choice to be who we want to be in whatever capacity… That’s that was very poignant.

Hilmar Wagner (42:54):

It’s a phrase that I have used with clients over the years, and there has been that same little bit of eyes widening.

Lindsay Guentzel (43:05):

The light bulb?

Hilmar Wagner (43:06):

Right. Especially when individuals are deep in their eating disorders, it isn’t even so apparent that the choice is no longer theirs. There’s this sort of public misunderstanding that eating disorders are a choice. No one would ever choose to have an eating disorder. People die of their eating disorders, and yet there’s this idea that if you would just start eating or just stop eating or just quit doing that, that reinforces that sense of just how to be blaze that sense of how involuntary this is. People have no ability to not engage in the behaviors that they have until they have the support to understand what those drivers are.

Lindsay Guentzel (43:51):

Hilmar, I can’t thank you enough for joining us on Refocused. It was beyond a pleasure. And once again, I just want to thank you for your commitment to helping those affected by eating disorders. It’s clear that you are incredibly passionate and empathetic about what this community is going through, and I’m so happy to know that there are people like you about the front lines. So just one, again, thank you for being here with us. And two, thank you so much for making this your life’s work. We are so lucky to have you working on this.

Hilmar Wagner (44:26):

Thank you so much, Lindsay. And I appreciate not only the time to talk about this very important topic, but for your efforts to support the awareness through this podcast as well.

Lindsay Guentzel (44:40):

Thank you. I appreciate that. I think once you’ve dealt with it yourself, anything you can do to make it easier for someone else is always a good path to go down. To learn more about The Emily Program and the work they’re doing, you can head to emilyprogram.com. I’ve also included the links in our show notes. And for more information on Eating Disorders Awareness Week, check out the hashtag EDAW2023. I’ve also included the link to help you find more information and resources in the show notes. There is so much ahead on Refocused. We’re going to get comfy in the month of March, talking all about sleep and ADHD. So make sure you are following along wherever you get your podcasts so you don’t miss out on any of the conversations.


Refocused is a collaboration between me, Lindsey Guentzel and ADHD Online, a telemedicine mental healthcare company that provides affordable and accessible ADHD assessments and treatment plans, including medication management and teletherapy. To find out how they can help you on your journey, head to adhdonline.com. Now, it’s time to thank the incredible team that makes refocused happen week after week. A massive amount of thanks goes out to the team behind today’s episode. That includes coordinating producer Phil Rodemann, our voice of reason, Sarah Platanitis, social media production from Al Chaplin. As always, shout out to Keith Boswell, Claudia Gotti, Melanie Mile, Suzanne Spruit, and the entire team at ADHD Online for all of their ongoing support.


Our show Art is created by Sissy Yee of Berlin Grey, and our music was created by Louis Inglis, a singer songwriter from Perth Australia, who was diagnosed with ADHD in 2020 at the age of 39. Links to all of the partners we work with are available in the show notes. To connect with the show or with me, you can find us online @RefocusedPod, as well as at @LindsayGuentzel. And you can reach us via email [email protected]. That’s [email protected]. Thank you all so much for listening, and we will see you back here very, very soon.

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