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78 m a s s a g e & b o d y wo r k n ove m b e r/d e ce m b e r 2 0 2 3 critical thinking | MASSAGE THERAPY AS HEALTH CARE Shutting Down Stigma Reduce Fat Bias in the Treatment Room By Cal Cates Let's talk about something the wellness industry loves to judge in ways overt and covert: body size. The wellness industry devalues fat people. Few of us have escaped Western culture's essential devaluation of the lives of people who live in bigger bodies. We need to start noticing it, owning it, and then commit to changing it. It's deeply harmful, and it prevents us from being the caring people we purport to be. It's also Ethics 101, my friends. In January of this year, the American Medical Association (A MA) adopted a new policy about how physicians should (and should not) use the Body Mass Index (BMI) as a measure of health. 1 Under the newly adopted policy, the A MA has chosen to recognize long-understood issues with using BMI as an indicator of health due to its historic harm, its use for racial exclusion, and because BMI is based primarily on data collected from previous generations of White, European, male populations. The policy notes that BMI is significantly correlated with the amount of fat mass in the general population but loses predictability when applied on the individual level. That means it's not a good measure of individual health. In fact, BMI is derived from a simple math formula (the result of a person's weight divided by the square of their height) created in the 1830s by a Belgian astronomer, mathematician, statistician, and sociologist whose goal was to establish a standard to measure "the perfect man." In his book, A Treatise on Man and Development of His Faculties, he made his goal and his bias clear. "If the average man were completely determined, we might consider him as the type of perfection . . . and everything differing from his proportion or condition, would constitute deformity or disease . . . or monstrosity." 2 Woof. If that doesn't sound like eugenics, I'm not sure what does. Personally, I'm cool to hop off that train at the next stop. START THE CHANGE The first thing we can do in our efforts to end fat stigma as massage therapists is to get clear about our scope. We are not registered dietitians. We are not endocrinologists. We are not qualified to provide any information for, or assessment of, our clients related to their eating habits, diet, or the size of their bodies. We can also skip talking about exercise levels or regimens with our clients. So, if you're doing that (and you don't have additional training and credentials to do so), stop doing it. Now. "There's a perception that weight stigma might feel bad but [that] it's tough love and it's going to motivate people," says Sarah Novak, PhD, an associate professor of psychology at Hofstra University. "But research shows that this isn't true." Shaming someone into "eating better" or "exercising more" leads to a decrease in health-seeking behaviors—and an increase in weight—over time. 3 Research also shows some important things about how health-care professionals care for fat people. Physicians are less patient with and less willing to assist patients who live in bigger bodies. They also spend less time with these patients and order fewer preventive tests for them. 4 Certainly, as massage therapists, we're not in the position to order preventive tests for our clients, but we would be wise to wonder if we exhibit the same behavioral patterns so many doctors exhibit when it comes to clients who are deemed overweight. ACKNOWLEDGE YOUR BIAS In their succinct and well-researched paper, Ending the Stigma: Improving Care for Patients Who Are Overweight or Obese, Dr. Ann Blair Kennedy (a massage therapist) and colleagues make clear recommendations about how we, as clinicians, can begin to shift these negative attitudes. 5 We must interrogate and acknowledge our own TAKEAWAY: When we can see the clients as whole people, it makes room for us to bring compassion to the impact of the multiple traumatic experiences they have likely had with other health-care providers.

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