I have seen a few patients recently who I did not offer surgery to. What? A surgeon who won’t offer surgery? Why? They were underweight and at increased surgical risk. For elective surgery, this is not okay. Given my hyper educated patient base in the Bay Area, I sent them the study data so they could see for themselves.
We are constantly bombarded by photos of underweight women, applauded on social media for how they look. This is not healthy, particularly to enter surgery. This is a toxic time of skinniness, with celebrities and GLP patients pushing the limits of thinness in a very unhealthy way.
BMI is your body mass index, based on your gender, height, and weight. It is for sure not a perfect approximation (body roundness index is a better indicator of health), but BMI is still a useful tool to discuss. A normal BMI is 18.5-25. If you look at antiaging and longevity studies, they indicate a healthy BMI is 22-23. You need a little fat and weight for many of your organ systems.
Everyone knows that high BMI patients have increased surgical risk. See my blogs here. But low BMI is just as dangerous, and maybe even more dangerous.
This has been studied. Patients with a BMI less than 18.5 have “substantially elevated surgical risk. This risk appears greater than that observed in obese patients, representing an often overlooked vulnerable population”.
Surgery is a huge stress to the body. Just like you may be fine right now doing your daily life stuff, if you tried to run a marathon it could hurt or kill you if you don’t have reserves.
Underweight patients do not have physiologic reserves. They have lowered capacity to weather the stress of surgery.
This can be due to malnutrition, chronic illness, low muscle mass, and frailty. Many are anemic or have vitamin and nutrient deficiencies. When healing, you need protein and nutrients to heal. In some of the studies they found underweight status was associated with increased heart operations and reoperation for bleeding.
I do elective plastic surgery. If you have appendicitis, you need to do the surgery- a ruptured appendix could kill you. But having small breasts and wanting a breast augmentation? Or fixing your muscle separation and loose skin after pregnancy by doing a tummy tuck? Those are not necessary surgeries.
SAFETY IS THE NUMBER ONE THING.
A low BMI is fixable. It is tough, and will take time, but it is better for your entire body health. It is better for your lifespan and longevity. You need muscle mass, bone strength, and fat to help with nerve and brain health. You need lots of nutrients and protein to heal after surgery, for prettier scars, and lower infection rates. Study after study shows women with eating disorders have wreaked havoc on their bones, brains, muscles, and fertility. The longer the low weight, the worse the effect. Surgery is a big stress to the body. Look at the JAMA graph. The risk is real.
I write this as an act of care. Your health is the most important thing.
The information provided on this website is for general informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider for any questions regarding your health or medical condition.
