**1. Introduction**

Binge eating disorder (BED) involves frequent overeating during a discreet period of time (at least once a week for three months), combined with a lack of control, and is associated with three or more

of the following items: eating more rapidly than normal; eating until feeling uncomfortably full; eating large amounts of food when not feeling physically hungry; eating alone because of feeling embarrassed by how much one is eating; and feeling disgusted with oneself, depressed, or very guilty afterward [1]. BED also causes significant distress [1] and is associated with various inappropriate eating behaviors. It is more common in females (3.5%) than in males (2.0%) and in obese individuals (5% to 30%) [2,3], especially those who are severely obese and those seeking obesity treatment: 17% at the time of surgery [4,5]. Moreover, BED seems to influence success after weight loss surgery [6]. Accordingly, it should be of interest to assess why people suffering from this disorder engage in various inappropriate eating behaviors in order to find a way to help them give up these harmful behaviors.

Inappropriate eating behaviors are like engaging in emotional eating or in binge eating. As a matter of fact, emotional eating behavior, the tendency to overeat in response to negative emotions, appears to be common in bariatric candidates (see for review [7]). Moreover, obese people with BED who are candidates for bariatric surgery are more likely to have severe binge eating symptoms than obese non-surgical individuals [7]. Bariatric surgery candidates also have more objective and subjective binge eating episodes per month than non-surgical weight loss patients [8].

According to the Diagnostic and Statistical Manual of Mental Disorders, DSM-5 criteria, binge eating and negative emotions are interconnected [1]. In their review, Dingemans et al. (2017) pointed that (1) several authors, using experimental studies, emphasized a relationship between emotional factors and overeating in individuals with BED; (2) these individuals were characterized by a higher prevalence of psychiatric comorbidities, exhibited higher levels of depression and anxiety; (3) they reported poorer mood especially prior to binge eating and can experience more negative stressors than subjects without BED; and (4) they can also feel more negative emotions (i.e., anger and/or frustration) related to interpersonal experiences [9]. Taken together, these results highlight a global emotional overload in individuals with BED. This emotional overload might increase the occurrence of binge eating. According to Polivy and Herman's (1993) affect regulation model of binge eating, this behavior could be implemented to decrease emotional distress or negative affects [10].

Rather than focusing on emotions themselves in individuals with BED, other works have focused on emotion regulation. According to Gross [11], emotion regulation refers to "shaping which emotion one has, when one has them, and how one experiences or expresses these emotions". Emotion regulation is conceptualized as involving emotion regulation abilities (i.e., the awareness and understanding of emotions, the acceptance of emotions, the ability to control impulsive behaviors and behave in accordance with desired goals when experiencing negative emotions), and emotion regulation strategies (i.e., use situationally appropriate emotion regulation strategies flexibly to modulate emotional responses as desired in order to meet individual goals and situational demands). Strategies can include adaptive ones such as reappraisal, problem-solving, and acceptance and maladaptive ones such as avoidance, rumination, and suppression. The relative absence of any or all of these abilities and strategies would indicate the presence of difficulties in emotion regulation, or an emotion dysregulation [12]. Regarding eating disorders, a recent meta-analysis by Prefit et al. [13] identified a transdiagnostic character of emotion regulation problems. Furthermore, compared to a control group without obesity, people suffering from obesity use significantly fewer cognitive emotion regulation strategies considered as adaptive regardless of their body mass index (BMI) [14] and they report using more emotional suppression [15]. Data also revealed that only emotional dysregulation significantly predicted binge eating vulnerability in a study involving 63 obese patients seeking surgical treatment [16]. Moreover, many studies identified lack of skills and strategies required to regulate negative affect adaptively and effectively (i.e., poorer emotional awareness and clarity, nonacceptance, difficulties with reappraisal, and with problem-solving) as being associated with eating disorders. Accordingly, individuals with disordered eating may have a greater vulnerability to using maladaptive emotion regulation strategies (i.e., rumination, avoidance of emotions, and suppression) [13].

In sum, the global emotional overload and dysfunctional emotion regulation abilities and strategies are then increasingly thought to be co-occurring risk factors in the onset and maintenance of BED by promoting maladaptive behaviors such as overeating and binge eating. However, according to Dingemans et al. [9], studies investigating the use of emotion regulation strategies amongst individuals with BED have found mixed results. Moreover, beyond emotional regulation, other researchers have outlined the role of impulsivity in this disorder. According to Giel et al. (2017), BED is also considered as a distinct phenotype, within the obesity spectrum, characterized by increased impulsivity and by an increased rash–spontaneous behavior in general and specifically toward food [17]. However, the simultaneous consideration of emotion regulation and impulsivity remains to be deepened. Therefore, there is a major interest to understand the impact of both emotion regulation as well as impulsivity in patients suffering from BED and seeking bariatric surgery.

Altogether, emotional overload (i.e., depression, anxiety), emotion regulation, and impulsivity may be associated with BED and could predispose individuals to developing and/or maintaining inappropriate eating behaviors among patients suffering from BED who are candidates for bariatric surgery. Given this, the primary aim of our study was to examine the associations with BED of emotional overload (depression, anxiety), emotion regulation, and impulsivity in obese people with and without BED. We expected people suffering from obesity with BED to present more depression, more anxiety, more emotion regulation difficulties, and more impulsivity than people suffering from obesity without BED (wBED). The second aim of our study was to examine the contribution of depression, anxiety, emotion regulation difficulties, and impulsivity to eating patterns observed in patients with BED. In this population, we sought to individuate which factors were significantly related to the assessed eating behaviors. More precisely, we expected that high levels of depression, anxiety, emotion regulation difficulties, and impulsivity were significantly related to emotional eating, external eating, and bulimic symptomatology. Improving our knowledge on BED is a necessary step to then develop indications of specific therapeutic strategies before surgery and, thus, allow their access to bariatric surgery and improve their outcomes after bariatric surgery.
