"You'll have to rip the
In-N-Out 4x4 out
of my cold, dead hands"
Probably the bun is the main bad ingredient in that picture.
I frequently eat burgers without the bun, yet once in a while I will allow the bun, and I suppose that is a form of carb creep.. which may be a thing that I am going through lately - allowing more and more carbs in my routine.
In an out has a off menu option, I think they call it "protein style", which is basically a lettuce wrap version of their burgers.
It's actually pretty good and done well.