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Background

Few studies have explored the impact of the COVID-19 pandemic on the eating behaviors, dietary quality, and changes in weight of post-operative bariatric surgery patients. In this cross-sectional study, a survey on eating behaviors and attitudes towards food was emailed to patients who had bariatric surgery before March 2020, with a response rate of 17.90% (99/553). Patient charts were reviewed for weight measures. Sixty-eight (68.69%) patients experienced weight regain and 23 (23.23%) experienced binge eating with 15 (65.22%) of those experiencing loss-of-control eating (LOCE). LOCE was significantly associated with grazing behavior (r=0.21, p=0.04), emotional over-eating (r=0.32, p=0.001), and food responsiveness (r=0.32, p=0.002). LOCE was negatively associated with dietary quality (r=-0.34, p=0.0009) and satiety responsiveness (r=-0.26, p=0.01). Grazing behavior was significantly associated with emotional over-eating (r=0.43 p<0.0001) and food responsiveness (r=0.51, p<0.0001) as well as negatively associated with dietary quality (r=-0.47, p<0.0001). Slow eating was negatively associated with grazing (r=-0.25, p=0.01), emotional over-eating (r=-0.30, p=0.003), and food responsiveness (r=-0.39, p<0.0001). When included in a regression model controlling for age and sex, emotional over-eating was a significant predictor of weight regain (β = 0.25; p=0.04). Our results suggest that maladaptive eating behaviors are associated with LOCE and poor dietary quality during the COVID-19 pandemic, however slow eating may be protective against grazing, emotional over-eating and food responsiveness. To help prevent weight recurrence after surgery, patients should be counseled on not only the importance of slow eating but also the triggers and signs for LOCE, which may be exacerbated by the pandemic.