As helping professionals, we have a unique opportunity to provide the power of healing touch and presence to a diverse set of bodies.

We do this with a kindness and tenderness in our hearts that is often unique to our profession.

The goal of this article is to introduce the idea of serving our clients from a Health At Every Size® framework. Health At Every Size (HAES) is an approach that recognizes body respect as a fundamental right that every person deserves.

There are three basic components of HAES:

Respect — respect for and honoring diversity in all its forms.

Critical Awareness — challenging assumptions and recognizing each individual’s unique, lived experiences and wisdom.

Compassionate Self Care — this is what may bring them to our massage table! Caring for self in a responsive way that listens and honors what feels right for the individual.

Why to Serve All Sizes

It’s already well established that it’s not OK to discriminate against a client (or anyone) based on race, gender, orientation, or religion. In fact, there are laws that prohibit it. But, what about size discrimination? Not only is it common to discriminate against a person based on their body size, but in many ways it’s socially acceptable and reinforced — so much so that you may not even realize or question it when it is happening.

Unfortunately, due to society’s deeply ingrained fatphobia it has been deemed unacceptable to be fat and acceptable to be thin. This harms all of us, regardless of our body size, because it risks giving a clean bill of health to a smaller person based on body size alone while missing other markers and lifestyle behaviors.

It also risks medicalizing a fat body that is perfectly healthy from a metabolic standpoint.

This size-based hierarchy keeps all of us scrambling — either to get small or to stay small — so that we are safe from receiving shame and judgment. Reading that last part may make you feel a little bit uncomfortable. I encourage you to lean in, dear reader, because outside of our comfort zone is where discovery and growth happen.

Let’s start with the very basics on this.

Whether we agree that everyone deserves access to unbiased health care or not, it’s not in our scope as a massage therapist to provide any weight interventions. Massage is not going to change a person’s body size or weight. It’s not in our scope of practice as massage therapists to talk about anything other than bodywork. So, as long as we stay in our lane, we’ve already created a more welcoming space for clients of all sizes.

Beyond scope and conversations, let’s think about energetic exchanges. If we are feeling judgmental towards the body that we are working on, that will impact the quality of care that we provide and the experience for the client as a whole. We don’t want that, do we? We’ll operate on the assumption that we all want our clients to have the best experience ever — not only for their healing but also for the reputation of our business.

Why don’t we want to discriminate? For starters, it’s mean — but it’s also harmful to health. As health care providers, we want to promote health, not harm it. Being exposed to stigma and discrimination in the health care setting is connected to medical avoidance or delays which can lead to worsening health due to untreated hypertension, injuries, or other symptoms.

Those conditions are the same ones that are blamed on weight. Therefore, we must analyze and consider: Is it the weight that is causing these problems? Or is it the stress of feeling shame, and the delays in medical treatment that allow medical mole-hills to turn into mountains?

One thing that massage therapists are universally keen on is stress. We see it every day — the physical, mental, and emotional impacts of stress in our clients. It is known that stress causes health problems. But the same can’t be said for body size. There are many people of size who are healthy, both inside and out.

Researchers Barry, out of MTSU explored and explain that body size is less indicative of health than physical (cardiorespiratory) fitness. Researcher Holt-Lundstad out of BYU has conducted research and meta-analyses examining lifestyle factors and all-cause mortality (read, “all of the ways a person could possibly die,”) and found that those with stronger social support systems and acceptance have a 50% increased likelihood of survival.

We have the opportunity to participate in change for these factors by creating accepting, supportive environments for our clients.

What You Need to Serve All Sizes

Creating a space that is welcoming for every body, involves examining our reaction to the “why” above, taking a look at our own biases and considering how we may evolve them, and looking at our practice through the lens of the client — what is needed to make them feel truly safe, seen, and served.

Make clients feel truly welcome. Create a space that is for every body – both physically and energetically. Welcome them, support them, encourage them, and soothe them. Who knows? They may just live longer because of something that YOU did.

How to Serve All Sizes

Now you’re ready. You say — “sign me up! I want to create a healing space that is inclusive for every body. Where do I start?” Read along for a start to finish tour of your treatment space and experience:

• Office location. When able to choose, choose an office with minimal stairs to access it — this will benefit all of your clients, regardless of size, and opens up doors for you to treat clients with injuries and disabilities as well. A ramp is good and expands our ability to include every ability and size of client. Nice wide doorways are a plus. An accessible restroom with bars to assist getting on and off the toilet are important.

• Paperwork. Don’t ask for weight. We do not need this information in order to provide effective bodywork for our clients.

• Office furniture. Chairs need be sturdy, very wide, not too low, and have an armrest. This will allow someone of ANY size to sit down and get up comfortably. While starting with a few pieces of furniture that are accessible is great, and it’s more affordable to transition furniture in a step wise process, it’s ideal to transition all furniture to accessible furniture so that no one ever has to ask to swap seats.

• Treatment furniture (your massage table and portable massage chair). Get to know the specs of your furniture. It’s important to understand working load and static load, and purchase furniture sturdy enough to accommodate the pressure of you and client — that is working load. Static load is the amount of weight an object can hold without any movement or motion. Working load is what we want to max out on so there is never any question about safety or stability no matter the size of therapist or client.

• Bolsters, blankets, and other accessories. Ask! Ask what your client needs in order to maximize their comfort. Remember that they are the wisest expert living in their body, so trust that they know exactly what they need to be comfortable.

We may make suggestions or offerings: “I have a lot of options for your comfort. Do you think you’d like extra blankets, pillows, or supports? Would you like a step stool or any assistance getting on or off the table? Feel free to speak up at any time if there’s something that will help you sink deeper into relaxation and healing.” These questions support every body, no matter the size.

• Conversations. Realize that the massage table is a place of vulnerability. Speak in a way that cherishes bodies and celebrates your client’s decision to receive care. Honor all that these bodies show up and do, — day in and day out — regardless of their size.

Clients sometimes make self-deprecating comments or statements, may ask questions about your body or your diet. Know that the purpose of these questions is always to diffuse an uncomfortable situation, so it’s an important clue for you. This may be based on their previous experience, or the energy that is in the room at current moment.

Resist the temptation to answer these questions or provide advice that is outside of our scope or may be triggering for clients. Instead, breathe and tune in to the energy in the room — what can be done to increase comfort?

Assure your client that every body is different and that the diversity is what makes the world a better place. Every body is deserving. Every body has value.

About the Author:

RanDee Anshutz, RDN, LMT

RanDee Anshutz, RDN, LMT, is a registered and licensed dietitian, licensed massage therapist and Certified Body Trust® provider. She is the founder of Synergy Health and Wellness in Bend, Oregon. Her team helps people improve their relationship with food and their bodies. She wrote “7 Health Practices to Try Today, No Matter What Your Weight” for the July 2019 print issue of MASSAGE Magazine. For more conversation or assistance with transitioning your practice to one that welcomes every body, seek out a Certified Body Trust® provider in your area.