Fat and Massage

“What do you do with a client who's really fat? I mean, like 300 pounds? How can you do them any good?”

It was a fellow student in massage school asking the question, a few years ago. I looked at him in surprise. He was a big guy, heavier than me, probably only 60 pounds shy of the 300 mark himself. The question struck me as bizarre. He went on, “How do you even get to the muscle?”

I don't remember what the teacher answered. She seemed as perplexed as I was. How do you get to it? You go around the adipose tissue or through it, just like with anyone else. If there's a lot, going through it can be poky, so you use a blunter “point” – the heel of the hand instead of fingertips or thumbs, say. But we all already did that. Even a skinny person, anyone who's not downright emaciated, has patches of adipose tissue. We'd been working with it for a year. What was the big deal?

But this student was plainly distressed, and I could see that we had left the realm of the rational. He was a good guy, not a jerk. But some people are a little nuts about obesity. We had left the realm of facts and were floating in the anxiety zone.

I find it slightly easier to work on fat people than to work on skinny people. Skinny people are easy to hurt: the muscle tissue lies smack against the bone without any padding and working it without pinching it takes some delicacy. Fat people often have a few places where I change techniques so as not to poke – upper arms and inner thighs, for example. Trigger point can be a little trickier. But actually the way the body lays in fat leaves almost all of the sweet spots completely accessible. It's just not a problem. And if you work glutes and abdominals at all, you already know how to work through fat.

Every body – every body, no exceptions – presents challenges and requires some improvisations and adaptations. There's no such thing as a normal body. They all have injuries and unexpectedly tender places; joints with limited range or hyperextensible ones. If you can't modify your routine to fit the body at hand, you simply can't do massage. The clients I find most challenging are heavily muscled men, weight lifters, for instance, who are simply damned heavy to move around, and present a lot of dense muscle acreage to get through. But I don't mind that. It's my job, working with different bodies. That's what I do. I got into this profession partly because I like bodies. I'm curious about all the shapes they can take. I don't want them all to be the same.

Over and over people – especially women – apologize to me for their fat, as if they were offending me. I'll be working on what seem to me like perfectly lovely calves, and suddenly my client will be explaining to me how she has always had thick ankles and the weight just seems to settle in there, and she's been trying to diet and . . .

There's always a moment of disorientation, while I try to figure out what on earth they're talking about. But when I do, it makes me unhappy. I want to say, “Look, there's nothing wrong with your ankles, or anything else about you! Your body's lovely! I'm enjoying it! If I wanted to do massage only on bony fourteen year old models, I would have mentioned it in my ads!” But that would not quite be professional either. I don't really know what I do. Murmur something reassuring and neutral, I suppose. It's all the odder because the people who do this are often leaner than I am. If apologies are in order, shouldn't I be apologizing to them?

I have worked on some very obese people, and their obesity has never been the main thing I have been coping with, during the massage. It's the regular challenges – what's the root of this tension? How do I work with this injured shoulder? What's the best positioning for this leg? – that occupy my attention. It simply doesn't make that much difference.

A couple years ago I had an email inquiry about massage, in which the writer said something to the effect of, “I'm very big, so please tell me up front if you have issues about fat.” I was glad she felt she could ask, but I was mortified, on behalf of my profession, that she felt she had to. No one should have to ask that. We're therapists, for God's sake. We have no business “having issues about fat,” any more than we should be having issues about shin splints or headaches.

I understand that many people – erroneously, I believe, but that's a different subject – think that obesity is a self-inflicted condition. But so what? We're surrounded by injuries and conditions that are more or less self-inflicted. I see lots of people who have run on concrete until their knees or ankles are a mess. I see long-time smokers who have an eerie, system-wide dessication of tissue. I see desk workers who have so abused their neck muscles, by staring motionless at a screen for twenty hours a day, that they can no longer turn their heads. Do I suddenly get on my moral high horse and refuse to treat them? Turn them away in disgust? I do not.

Nor do I tell people they should lose weight. If they haven't been living in a particularly remote section of the Carlsbad Caverns for the last fifty years, they already know that, and they've already tried to do it – repeatedly, and at a grievous expense of spirit. The last thing they need is for their massage therapist, the person they go to for comfort, to start harping on the same theme.