Intestinal obstruction (IO) is a common surgical emergency[1]. While many factors influence management, Body Mass Index (BMI) has emerged as a potential determinant in surgical decision-making.To examine the relationship between BMI and the likelihood of requiring surgical intervention in patients with intestinal obstruction.A prospective study involving 385 patients diagnosed with IO was conducted at Shyam Shah Medical College, Rewa (M.P.), from September 2022 to March 2024. Patients were categorized based on BMI and management type—conservative or surgical.Overweight individuals (BMI 25–29.9) formed the majority of the cohort. Although overweight and obese patients were more frequently managed surgically, the association between BMI and surgical intervention was not statistically significant (p = 0.073). While higher BMI appears associated with a greater tendency for surgical management in IO, this relationship was not statistically significant in our study. Further multicentric trials may help validate BMI as a prognostic indicator in surgical triage.