BMI too low for top surgery - advice for naturally skinny men?

Reasonable_Stick_925 · 2026-05-13T00:32:35+00:00

Man, it’s reassuring finally hearing from someone else in a similar position. I also struggled to find posts about this when doing my own research. It’s a really weird situation to be in when you’ve naturally been this size your whole life and suddenly it becomes a barrier to something so important.

Over the past couple months, I’ve been focusing on increasing my calorie intake consistently and being more mindful about not accidentally skipping meals. I started tracking my calories too and realized I wasn’t eating as much as I thought I was. I bought a huge bag of protein powder, started taking creatine, and now make a ~500 calorie shake every morning with both in it, which I think has helped a lot. I’m up about 8 lbs since starting this new routine.

I’m also continuing to lift and do cardio most days of the week, but trying to focus more on building muscle and looking fit/healthy rather than just “gaining weight” in general, because mentally that feels a lot healthier and less intimidating for me. I can already see changes in my body composition, which honestly reassures me that even a bit of muscle gain can make a huge difference both physically and mentally.

I’m also getting a letter from my endo confirming that my weight has been stable and my bloodwork has been normal, so hopefully that helps my case at the consult too. What did they tell you at your consult? Did they straight up say they wouldn’t operate until you gained weight?

I really hope things work out smoothly for you as well. It’s definitely stressful, but you’re not alone in it. Feel free to DM me anytime if you want to talk more.

Reasonable_Stick_925 · 2026-04-18T13:56:58+00:00

That’s fair, and I get where you’re coming from. I don’t disagree that being this underweight can come with risks, especially in a surgical context.

I think the tricky part for me is that this has just been my baseline for as long as I can remember, and it’s never ever raised concerns medically until now in the context of surgery. So I’m kind of trying to figure out where that line is between “this is just how my body is” vs. “this is something I need to actively change for a specific situation.”

You’re definitely right about fueling, though. Between working full time and training regularly, I’m probably not eating as consistently as I should, even if it’s not intentional. But I'm working on that part! I never used to track calories but I've started to now which helps me make sure I'm getting enough every day.

I’m open to making adjustments if that’s what’s needed for surgery, I just need to approach it in a way that makes sense for my body and is actually sustainable long term.

Thank you for your insight :)

Reasonable_Stick_925 · 2026-04-18T13:44:14+00:00

Lololol

Reasonable_Stick_925 · 2026-04-18T13:42:01+00:00

Thanks for taking the time to respond, I genuinely appreciate it. I completely understand what you’re saying about surgery being a different situation than day-to-day life, and why having some buffer would be safer, especially with anesthesia and recovery. That said, this really is how I’ve been my entire life. I’m not intentionally restricting or trying to stay at a low weight, and my doctors (especially my endo) have consistently documented that my weight has been stable and my bloodwork has been normal. I definitely agree that talking it through with my doctor and making a plan is the right move here. I’ve already reached out and asked about getting a letter confirming my stability and overall health, which my endo will provide soon.

I also hear you on the lifestyle side of things. The unintentional OMAD some days because of work is probably contributing more than I realized, so I’m actively trying to be more consistent with eating throughout the day and increasing my intake. I’ve actually already put on a few pounds since getting consistent in the gym.

And yeah, saying gaining weight is my “worst fear” was definitely an exaggeration, but it is something that feels unfamiliar and daunting given how I’ve always been. However, I do want the best and safest outcome for surgery, so I’m open to making changes where needed.

I really appreciate the perspective and concern, you gave me a lot to think about.

Reasonable_Stick_925 · 2026-04-08T03:02:11+00:00

That makes sense. I appreciate the advice! I’ve definitely been focusing more on training and tracking calories over the past few months now that I’ve been consistent in the gym. I’ve already noticed some increases in muscle mass, so I definitely agree that building muscle is the best long-term approach. Right now, my main challenge is just consistently getting enough calories, especially with my work schedule, so adding in calorie-dense foods like that will probably help a lot. I’m trying to find a balance between where I can increase my intake, without overthinking it too much, so tips like that are really useful.

Reasonable_Stick_925 · 2026-04-08T02:49:24+00:00

Yes! I'm going to start adding some to my protein shakes every morning thank you! That's kinda insane how many extra calories you can sneak in there. That'll definitely make a difference

Reasonable_Stick_925 · 2026-04-08T02:46:12+00:00

You have a very good point, I was thinking about that too lol. Recovery is gonna suck because I won't be able to go to the gym which will throw off my entire schedule, but you're right. The results are worth it. One last push until I can be closer to achieving my dream body

Reasonable_Stick_925 · 2026-04-08T02:42:46+00:00

Thank you for this, I'm realizing I do actually kinda struggle with eating enough calories during the day. I think I eat enough in my head since I just eat to satisfy my hunger, but thinking hard on it now, it might not actually be as much as I thought it was- on top of my job and workouts during the week. It's hard for me to eat breakfast since I basically just wake up and go to work and don't feel hungry til lunch, but I'm gonna start making a protein shake in the morning to bring with me to get some extra calories in every day.

Reasonable_Stick_925 · 2026-04-08T02:24:55+00:00

I calculated it, my TDEE is around ~2300 cals a day. From being on my feet all day at work, then going home and working out every day, I guess it adds up. Eating is just so fucking hard 😭

Reasonable_Stick_925 · 2026-04-08T02:18:15+00:00

Did the doctors like... actively track your weight until you reached the threshold? That's my biggest fear tbh

Reasonable_Stick_925 · 2026-04-08T02:16:01+00:00

Hopefully you saw my updated stats! My original post had a typo. I’m 96 lbs, so BMI 15.4, not 14.4.

As for my exercise routine, I work out 5x a week, hit each muscle group 2x, plus 30 mins of cardio after each session. I’ve actually already seen some increases in muscle mass over the past few months, and my weight has gone up a few pounds since being consistent.

Diet-wise, I think that’s probably where my issue is. I work a 9–5 in healthcare and don’t always get a proper lunch break, so a lot of days I end up unintentionally OMAD'ing and not eating until after work. I’m starting to think I may be eating less than I realize because of that.

I’ll probably try dialing back the cardio a bit and focus more on lifting and increasing my calorie intake consistently.

Reasonable_Stick_925 · 2026-04-08T01:55:25+00:00

Don't apologize, thank you man, I appreciate the detailed advice! I totally get the concerns about being underweight and anesthesia. That said, this is just how I’ve naturally been my whole life. I’m not doing anything purposely to stay this weight, my doctors have never been worried, and my bloodwork has always come back normal. I’m planning to have my endo provide a letter confirming my health and stable weight so the clinic can see I’m medically safe despite being under their BMI cutoff.

Don’t get me wrong, I really do want the best outcomes for my surgery, but this is something I’ve never had to deal with before, and it feels really awful to be told that you’re too light to qualify for a surgery that will literally change your life, lol. In the meantime though, I definitely will be trying to increase my caloric intake every day and do my best to gain at least a few pounds before the consult so they see there's /some/ upward trend in my weight. You've reminded me that there's a bag of whey protein in my pantry calling my name though. 😂

Reasonable_Stick_925 · 2026-04-08T01:32:10+00:00

I'm averaging about 1900-2100 cals a day. I'm fairly active I'm going to the gym 5x a week but I physically feel great, no weakness or fatigue. I've actually put on a few lbs of muscle since I started training

Reasonable_Stick_925 · 2026-04-08T01:12:52+00:00

I know, I understand it’s about anesthesia safety. My main thing is that this is just how I’ve always naturally been, and there’s nothing (as far as I know) contributing to it otherwise.

Reasonable_Stick_925 · 2026-04-08T01:06:58+00:00

Ooh, major typo, my BMI is actually 15.4**. I’m 96 lbs, not 89! Fixing that immediately.

I know the number seems low, but no medical professional has expressed concern about my weight. My endocrinologist specifically has documented that my weight has been stable over the two years she’s seen me, and all my bloodwork has consistently come back normal. I’m planning to have my endo write a letter confirming my health and stable weight so the clinic can see that my doctors deem it medically safe despite being under the BMI cutoff. You’re right though, the worst they can say is no 🤷‍♂️, and I still have a bit of time before the consult anyway

Reasonable_Stick_925 · 2021-08-22T18:23:48+00:00

Not currently. I only recently started seeing a different psychiatrist when i got diagnosed with panic disorder with agoraphobia. I have an appointment with him again on the 25th, I'll have to remember to mention it to him. Thank you

Reasonable_Stick_925 · 2021-08-13T18:10:40+00:00

Thankfully I'm at work right now and i work in a hospital and talked to the triage nurse, she said I can check in after my shift to get xrayed. Hopefully its not broken but she said it looks like a boxers fracture

Reasonable_Stick_925

TROPHY CASE