The development of eating pathology is a concern following bariatric surgery, even in the absence of any pre-surgical psychopathology. No consistent risk factors have emerged in the literature to identify those at greatest risk. However, post-surgical guidelines encourage eating behaviors that would be considered disordered in other contexts. We present a case of an adolescent developing bulimia nervosa following gastric bypass surgery and the escalation of her symptoms from diligently following recommended food behaviors to a full-syndrome clinical eating disorder. We discuss the differences between appropriate post-surgical eating behaviors and disordered eating behaviors. We provide recommendations for clinicians to screen for eating pathology and referrals to an interprofessional treatment team to address eating disordered behaviors and cognitions.