**4.5 Maladaptive eating: Binge eating (BE) disorder**

Maladaptive eating patterns after BS have impact on weight and psychological outcomes [45]. One of these abnormal eating patterns is BE disorder which is defined as 'the consumption of large quantities of food during a short amount of time without being in control of this behavior', and is strongly associated with psychological distress [26]. BE disorder predicts poorer weight outcomes post BS, resulting in smaller BMI reductions as well as more WR [46, 47]. Despite the physical limitations of BS on stomach capacity, BE is not always abolished and many of those who had BE before BS still had feelings of loss of control when eating even small amounts of food post BS [37, 47]. Following RYGB, patients who regained >10% of their EWL% had significantly higher frequencies of BE and loss of control [46], and these maladaptive eating behaviors were significantly correlated with greater WR [46]. Follow up of 96 patients post RYGB two to seven years after surgery showed that binge eaters increased their BMI by 5.3 kg/m<sup>2</sup> compared with 2.4 kg/m2 increase in non-binge eaters [48]. Likewise, among LAGB patients, the prevalence of eating disorder increased from 26.3% to 38.0% over one year post surgery, an increase that correlated with poorer WL outcomes [37].
