by Kristine Shultis, CTN, LMT, NCTMB, Reiki Master
When I first opened a private practice as a massage therapist nearly 10 years ago, I felt dismayed every time an overweight patient walked through my door. How was I going to help this person? What challenges was I going to face? Would I be up to the challenge? Every time a person with serious health challenges comes in, I face these questions. With the overwhelming number of people in the US facing obesity, the challenge of providing good quality massage therapy that meets the patient’s needs is growing.
Obesity Defined
Obesity is defined by the American Obesity Association as a Body Mass Index (BMI) of 30 or greater. A BMI of 25 to 29 is considered overweight. Obesity affects at least 69 million Americans or more than sixty-four percent of adults. Obesity is a chronic disease with a familial component. The tendency to become fat is fostered by our American lifestyle: lack of physical activity combined with abundant, tasty, high-fat food. Obesity increases one’s risk of developing conditions such as high blood pressure, diabetes, heart disease, stroke, gallbladder disease, cancers of the breast, prostate and colon. Obesity may shorten lifespan. Persons with obesity are also sometimes subject to mental distress due to poor self-esteem and discrimination.
Caring for Obese Patients
Caring for the obese patient was not what I thought it would be. During a practicum, an Instructor was asked about obese patients. He said, “Close your eyes and dig in.” Of course this is terrible advice and I’m sure it was meant to be a joke, however, it stayed with me. More and more I realized that working with obese patients takes special skills just like working with patients with any other chronic disease.
When working with obese patients, a thorough health history should be taken. (This should really be done for all new patients.) I have had a few new patients complain to me about the length and thoroughness of my intake form: “My last therapist never had me fill out a long form.” I explain that there are health conditions for which special techniques are used or conditions that contraindicate massage. “You should be pleased that I am asking you these detailed questions,” I explain. “It shows how much I want to help you feel better instead of just giving you a generic massage.” Most patients respond positively when they see the intake form in this manner. To say that the health effects of obesity are numerous is an understatement. The American Obesity Association lists 28 different categories of medical conditions for which persons with obesity are at risk for developing.
Most massage tables are not made for the extra-wide patient. I have a 31” table and I do have some patients whose arms hang off the sides while laying supine. Try to make the patient as comfortable as possible using bolsters, rolled up towels, etc. while in the supine position. Some obese persons have difficulty breathing while in this position. If this is so, you may want to use a massage chair. Most obese patients will need help sitting up from the supine position and may have difficulty turning over without help.
It has been my experience that many obese patients, especially women, lack positive touch in their lives. You, as the therapist, have an opportunity to have a very positive effect on your patient’s life. If a patient expresses dissatisfaction with his/her body, I always tell him/her what a positive step s/he is taking by getting massage therapy. Use this opportunity to enumerate the many benefits of massage therapy for the patient.
Pressure
It has been my experience that most obese patients prefer light pressure. At first, this went against what I thought would be true. However, according to the American Obesity Association, increased bodily pain as well as musculoskeletal pain is reported more by persons with obesity as compared to persons with other chronic medical conditions. There is a possible physiological explanation. Skeletal muscle tissue has more density than adipose tissue. The cellular make-up of these tissue types differs greatly. Skeletal muscle tissue is striated and composed of numerous microfilaments. This allows the body to move voluntarily. Adipose tissue is a specialized form of connective tissue. Connective tissue has cells scattered throughout an extra cellular matrix. In this case, the tissue is loose and its job is to store fat. Due to these differences, persons whose bodies have more stored fat need lighter pressure.
Products
There are a number of specialized products on the market today that may make obese patients more comfortable during the massage. These include wider massage tables, specialized bolsters for women with large breasts, larger body cushions and bolsters, and neck supports and elevated face rests.
Conclusion
With the growing number of obese persons in the world, massage therapists need to be educated about this growing health risk and how to care for these patients. You may find that you must adapt your style and equipment to the obese patient for both your comfort as a therapist and the comfort of your patients.
