Background: Binge eating disorder (BED) and obesity in adolescents is associated with variations in social cognition and emotion regulation. The current study aimed to evaluate the Theory of Mind (ToM) abilities in adolescents with obesity with and without BED and to examine how they related to emotional and psychopathologic evaluations. Methods: One hundred twenty-eight adolescents comprising 32 non-BED adolescents with obesity, 32 adolescents with BED and obesity, and 64 healthy controls (HC) completed a battery of tests to analyze their social cognition and clinical psychopathologic profile. Results: Patients with BED and non-BED patients with obesity showed poorer performance in emotional regulation and social cognition tasks compared with normal-weight adolescents without BED. Various correlations were evident between depression, emotional regulation problems, and eating attitudes and patterns. Conclusions: Patients with BED and non-BED adolescents with obesity showed a decline in ToM tasks, independent of their clinical psychopathological profile. Consistent with other studies, this is the first study to assess both social cognition and emotion regulation skills in adolescents with BED and obesity.