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 a serious health challenges comes in, I face these questions. With the overwhelming number of people in the world facing obesity, the challenge of providing good quality massage therapy that meets the patient's needs is growing.
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 encouraged by our lifestyle which includes a lack of physical activity combined with abundant, good-tasting, high-fat food. Obesity increases one's risk of developing conditions such as high blood pressure, diabetes, heart disease, stroke, gallbladder disease, cancer of the breast, colon and prostate. The latest research shows that obesity may shorten lifespan. Persons with obesity are also subject to mental distress due to poor self-esteem and discrimination.
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. 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 at least 28 different categories of medical conditions for which person's with obesity are at risk of developing.
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 (fat) 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.
A treatment option for obese patients is warm stone massage. Although contraindicated at higher temperatures for diabetic patients, warm (not hot) stone massage is both gentle and therapeutic. Warmth increases blood flow, circulation, metabolism and lymph function while decreasing tension.
Most standard 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. Some obese persons have difficulty breathing while in the supine position. If this is so, you may want to use a massage chair. Many obese patients will need help sitting up from the supine position and may have difficulty turning over without help.
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 larger breasts, large body cushions and bolsters, and neck supports and elevated face rests. If your practice has a large number of obese patients, it will be worth the investment in proper specialized equipment for both the patient and the therapist.
I urge all therapists to read and study about obesity. Education is one of the most important aspects in learning about any chronic condition. It will help you understand the needs of your patients.
Working with obese patients can be challenging, but with the proper education, attitude and equipment, you will be successful in treating this growing segment of the population.
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