BACKGROUND The prevalence of both compulsive eating patterns (bingeing and "grazing") and psychosocial distress and/or psychiatric co-morbidity in patients seeking bariatric surgery has been documented. While surgery is often seen as the solution, research has shown that these problems can persist postoperatively and may adversely affect outcome. This paper will describe a postoperative psychotherapy group process designed specifically for gastric bypass patients. METHODS A semi-structured cognitive-behavioral group therapy program adapted from a treatment program for compulsive eaters was designed for patients who had been identified (by questionnaire and clinical interview) as having compulsive eating problems before surgery. Therapy addresses eating patterns as well as the emotional adjustments following surgery. RESULTS 16 12-week therapy groups have been conducted to date. The groups are small and designed to help patients understand the stages of postoperative adjustment and the tasks, both eating-related and psychological, associated with each stage. Feedback from participants has been very positive with patients reporting the need for a therapy group in addition to the traditional support group. CONCLUSION Since both disturbed eating patterns and psychological difficulties are seen following surgery, it is imperative that treatment programs be developed to address these issues. The group process is a highly effective intervention but must be designed for the special needs of these patients. Measures of success need to take psycho-social factors into account as well as eating behaviors and weight loss. Outcome studies are needed to compare those receiving treatment vs those who do not.