Having fully internalized the gym lifestyle as a core identity and worldview — not just someone who works out, but someone who has been fundamentally converted. Buff pilled people structure their lives around training: sleep schedules exist for recovery, meals are macro-tracked, social plans get measured against leg day. It can be admired or gently ribbed depending on context, but the sense is always one of total ideological commitment to the pursuit of physical development over basically everything else.
He turned down a concert because it conflicts with his push day — yeah, he's completely buff pilled.
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