Submitted By Anonymous
A regular female client of mine is a very nice lady, but she is, in a word, obese. Any massage therapist knows how layers of adipose tissue make accurate assessment and treatment difficult. I have two hourly rates reflecting complexity and demands of the treatments, with one being $10 higher than the other. This client originally saw a coworker of mine in an office we shared, and then she quit doing massage therapy. I originally charged this lady the lower rate, but realized this was not sensible, particularly since I often apply kinesio tape and/or used advanced techniques. If she were to question the higher rate, I would tell her that my rates are based on advanced training and skills; I draw upon for individual cases. (Working on an obese person requires extra finesse and energy, to say the least.)
If you were confronted with the same situation again, how might you handle things differently?
Response from Anonymous
I would handle the same situation in the same way.
Response from Institute for Integrative Healthcare Studies
Charging differently for a client who is obese walks a very fine line of inappropriateness. It is illegal to discriminate based on physical characteristics. Would you charge less for an extremely skinny or short person or more for an extremely muscular or tall person? Would the fee be different for a person with Parkinson’s disease, or a person confined to a wheelchair? An hour-massage should be charged the same no matter who the client is, what they weigh, what they look like or what their disability might be. If the client signs up for a 90-minute massage, then yes, of course the charge would reflect that.
You may charge differently for various types of massage, and using kinesio tapes can justify this in some cases, as long as you do the same for ALL the clients you use the tape on. Just basing your rate on advanced training is not a reason for increased charges, unless you charge the increase across the board.
Individuals who are considered obese already experience a lot of prejudice and discrimination based solely on their weight. Who is the one to determine at what point obesity becomes so problematic that a massage therapist must increase the fee? Is it by sight evaluation alone, or is the client weighed. If a bodybuilder came in and weighed the same would he or she also be charged because of the extra pounds, or since they are more “fit,” would they be excluded? Is a pregnant woman charged extra during her third trimester because of her weight increase?
All these questions need to be asked in justifying the increase of price for one client over another. As massage therapists we need to ask ourselves if we are being fair and just to our clients, and are we obeying the law with regard to setting prices.
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What about charging more for a client that is just plain difficult – ALL THE TIME! There are no laws regarding discriminating against a person that is rude, late, etc.
Don’t schedule with them anymore. Problem solved.
I agree with Sharyl but you need to let her know that you cannot see her any longer. Read up on ways to do this respectfully. As for clients being late, I have it in my Policies Form that I reserve the right to shorten a massage by the amount of time they are late… 10 mins late = a 50 min massage. Unless I have a schedule constrant I will give a full massage to regular clients who don’t usually arrive late… we all need grace. I had a constantly difficult client for a while. It’s a growth opportunity for us as therapists and as people. Each situation is unique but often offering them respect and love in return for their being difficult can change them and then it’s a blessing to both of you. Good luck!
Linda – great response to this issue. As you illustrated, there are all types of clients and charging more should only cover the services, not the physical make-up of the person. We did have one client who visited a spa and was in a wheelchair. It would take two people to get her onto the table and back into her wheelchair, but nothing extra was charged – and she needed the work.
I have been and LMT for almost 20 years and you have to be kidding to charge extra for a person of different weights. I charge for my time and that’s that. PAMI
The decision to charge more or the same should be based on the individual performing the service. Personally I would have no problem if a colleague of mine “charged more” or added a fee to account for more effort. I don’t charge extra for someone with extra baggage mainly because I don’t have a large clientele and I would not want negative feed back affecting my changes of growing a larger clientele if I decided to practice longer hours. However if I provided an awesome service to the public and I had the clientele backing my practive, I would absolutely consider charging more. My massage services are a busisness and a business is in the
oops, wrong click.
I didn’t mean to “like”
The decision to charge more or the same should be based on the individual performing the service. Personally I would have no problem if a colleague of mine “charged more” or added a fee to account for more effort when working on fat, overly muscular, or just larger people in general. The comments and this article in general are bias and very disturbing to me as a business man. Those that commented and who are in the line of work to just make people feel better, obviously don’t have any experience running a business.
The only reason I don’t charge extra for someone with extra baggage is mainly because I handle a smaller clientele and I would not want any negative feedback affecting my changes of growing a larger clientele if I decided to practice longer hours. My fees can change, over the years I’ve switch to charging by the session. My session runs 60-90 minutes and my time and effort may vary “based on the client”. However, if I provided an awesome service to the public and I had the clientele backing my practice, I would absolutely consider charging more. My massage services is what pays my bills and provides me an income. I’m in the business of making an income from my experience and hard work as an LMT. If I want to schedule appointments with individuals that are “Obese” that is my choice. The same as if a client wants to “discriminate” and schedule a massage only with a female therapist. This is the USA people. If an overweight person wants to receive a quality massage, they may need to expect to spend more than someone that is not overweight. And who are you guys kidding….obviously if someone whom is obese wants to get a massage, more than likely they want a spa massage. In my 8 years as a massage therapist, the people that want therapeutic massages are individuals that care about their health.
Oh dear, it doesn’t sound like you have even a basic understanding of the complexity of obesity. Your comment that obese people only want spa massage and don’t care about their health is the most ignorant thing I can imagine being said on the topic. In addition, as much as you talk about the business of massage makes me think you’re not fully focused on your clients but on your bottom line. And that translates to a quality of work I would not pay for.
Unfortunately ignorance may keep your from an extremely satisfying and well established deep tissue massage. I may not have the same understanding about obese clients as you, but this is probably to my benefit. Fat people are not like skinny people. Their complexity lies within their sheer volume and this adds an additional effort to my services that I want to make sure I’m paid for. Nor do I find myself prejudice, because I don’t turn down business from potential retuning clients based on their height, weight, gender, race, religion, sexual preference, educations, wealth, or looks. If they can afford my rate, I will give the best massage I can offer. I actually discussed this article with a friend of mine yesterday. His response was to compare this topic of added fees for fat clients to how airlines charge more for passengers that travel with baggage heavier than their 50 pound limit.
There are many reasons why the fees are added:
1) the airline employees have to lift heavier luggage which puts more risk on the employer covering injuries caused by heavy lifting.
2) There is a delay for the whole scheduled flight, because it takes longer to load and unload the plane because of heavier baggage
I’m sure there is other in-depth reasoning I could try and explain – from the additional cost of workers comp coverage, more use of fuel, fairness for other passengers that don’t tote heavier luggage. These comparison could also relate to the increased costs in health insurance the public incurs because the lack of control obese people have to limit their calorie intake.
This is the world we live in and if a therapist want to give away free massage effort, then that is their right. Whom am I to say their ethics are damaging to the massage community? In the end…Time is Money, and if a therapist has to work longer and/or provide more effort in order to provide the same quality massage to an Obese person, then someone is going to pay. As an individual I only want to pay for the work provided, and not for someone else’s expenses. It’s not right to charge non-obese individuals more when they take better care of their health.
FYI — I’m on vacation, and I can debate this article all week long till I’m blue in the face.
Kris, your attitude contains judgement about obese people, and that seems to color your view of what they deserve. Simply taking better care of their health will not necessarily make obese people thin. There are physiological factors at work, and millions of years of evolution which allowed the fattest to survive is felt today in our culture of ubiquitous high-calorie food and low impact work environments. Most obese people fight very hard for years and years, never to reach their goals, and every day feel the rejection and judgement of those who think they don’t care enough about their health to change. I’m sure you are not obese, and you don’t seem to care to learn, but I think it would enhance your perspective to have a talk with someone in your life who is large. Share this message. Some of your great massage might take on a more sensitive awareness of what different body types need, and believe it or not, there is a person inside that body on the table who can sense your attitude about them.
Your analogy to airlines charging based on baggage weight is a very quantitative view. Where I think it fails is in applying judgment to why one person’s baggage might weigh more. Let’s say person A is carrying a thousand pounds of jewelry onto a flight, and person B is carrying an thousand pounds of medical equipment to maintain that person’s life. In the strict view of baggage weight both should be charged the same. Let’s add that person A is a billionaire and person B is poor. Another way to look at the baggage analogy would be that if airlines and massage therapists were just basing cost on weight/size, they every person should be weighed and charged an exact amount by weight. I’d say it’s unethical to increase your fee for an obese person without decreasing the fee for a thin or “easy to massage” person. It could get complicated, weighing, and looking at, for example, degrees of connective tissue adhesions or joint dysfunction. Would you charge more for an athlete who didn’t ice their knee after running, causing you to work harder to drain the tissue? All this would make your intake last longer than your massage!
It’s hilarious that you point out how I’m being judgmental…when all you typed in the first paragraph was your assumptions, and backlash about my poor disregard to fat people. One it doesn’t matter how I feel towards anyone with disabilities….all I’ve ever stated were analogies, facts and opinions based on business. If you would like to read my perspective on fat people then keep readying…
1. I’m probably 30-40 lbs. over my ideal weight, and I’m not thin. But I’m nowhere near obese.
2. I’m related to several Obese people, and I love them like the rest of my family.
3. I do work on Obese people, and I don’t discriminate. But they don’t receive the same quality massage than I can give to a non-fat person, only because it is impossible to massage with the same amount of effort on someone that weighs considerably more.
4. And this might surprise you: I’ve dated fat women before (but never anyone considered obese)…and I’ve found them just as physically attractive than I have for the non-fat women I’ve dated.
5. And to be the most dramatic; I do think it is wrong for obese people to obtain handicap parking tags. Ethically I would make them park at the back of the parking lot for obvious reasons.
Unfortunately I think we will have to agree to disagree, because there is a majority of people reading this article that believe certain people deserve special treatment and accommodations. My main concern is that you don’t believe in the concept that individuals should take responsibility for negative situations they find themselves in that are outcomes from other underlining issues. For example: So do you believe we should cater to people that have alcoholic tendency’s and decide to drink and drive? So if an alcoholic can’t control the need to drink, then do auto makers need to be required to install breathalyzers in every automobile that is made? This way alcoholics are not being judged by their lack of control. My analogies are not judgmental…they are simple and point out the fact that people should take responsibility for the situations they put themselves in. If you are fat, expect to pay more when you use more than a non-fat person. Compared to a thin person does a fat person typically have more food expenses, do their clothes cost more because they require more cloth materials, or do their vehicles burn more fuel because more weight is having being transported? And in the common sense of this article… are fat people heavier to lift and have do they have a larger body mass? So the “Justifiable” answers to all these questions are? Stop thinking that individuals deserve special circumstances. My opinions that I’ve stated are “Justifiable” and not Judgmental. If a License Massage Therapist wants to charge a fee that is fairly calculated based on additional effort then that the therapist’s right. If I was going to be judgmental…I would tell you I wouldn’t work on obese people because most of them stink of sweat and fart more. But I’m not ignorant and I know that is not a true statement.
So in conclusion, I dispute the idea that fat individuals should be given special treatment. And again in your response all I’ve read from you is that you judgmentally suggest that I have negative prejudices towards obese people. When in fact I have a very sound understanding of the feelings and hardships “overweight disorders” can have on individuals. Who’s to say I was not fat at some point in my life? Let’s discuss the function of the digestive system. It is actually very simple to understand…fat is produced and stored when the body intakes more calories than what are burned. Yes we can agree, there are factors that can slow and speed the metabolism of a person causing additional effort to burn or store more fat than others. But these factors are still based on these simple basics concepts. AND a fat person can “simply take better care of their health” by not eating more calories in which they burn. And if they reversed the calorie intake by actually burning more than what they intake their body would start to burn their stored fat and causing them to become thinner. So there is an additional 2 minutes of CEU’s that you can add to your experience =)
I’m sorry you find my attempts to clarify some points hilarious. I was was responding to your statement:
” I may not have the same understanding about obese clients as you, but
this is probably to my benefit. Fat people are not like skinny people. Their complexity lies within their sheer volume and this adds an
additional effort to my services that I want to make sure I’m paid for.” And this statement: “obviously if someone whom is obese wants to get a massage, more than
likely they want a spa massage. In my 8 years as a massage therapist,
the people that want therapeutic massages are individuals that care
about their health.” To me that sounded like you know all you care to about obese people and are willing to apply certain biases to them based on their weight. I was pointing out that there are other factors at play, if you wish to consider them. I’m glad you know and love some large people, but I don’t think you grasp the abysmal side of living with an eating disorder and trying to change when your cells constantly scream to be fed as you continue to starve them, all while thinner people look on with pity or disgust. If it were easy to just take in fewer calories (which I’ve known about since I went on my first diet at age 8, no CEU’s for that) why would so many people be and remain and re-gain fat? It may be a “simple” concept, but clearly it’s about as easy as simply standing on your head all day. What am I saying all this? Just to help you realize that if you carry biases about any client on your table you will not be able to treat the whole person as capably as someone who is without bias.
As for handicapped parking, you may not know the reason for someone’s obesity, perhaps an underlying heart condition, lipidema, or other problem that makes exercise impossible and metabolism slow. And that placard may be the only thing that allows them to get to work.
Debate On:
Isn’t it better to find your comments hilarious rather than resentful?
My understanding towards obese people is very straight forward. It is easier to point out the facts and teach someone of the science of how the body produces/burns fat and why the speed of metabolism is different for everyone, than it is to argue with individuals that have a soft side towards being obese.
Have you ever heard of the phrase, “you reap what you sow”? Skinny people make healthy decisions, whether they have a proper diet, or they are extremely active. Once the fat is burned it is easier to keep burning new fat. So the longer you put effort into being healthy the easier it is to stay healthy. It takes dedication and knowledge to lose an large amount of weight. If you want to be like skinny people then you have to act like a skinny person. I know it is not easy. I personally have an extra 30-40 of belly fat and I expose my self to diabetes, higher cholesterol, more tension to my joints, higher costs of replacing of my clothing, less energy and higher stress, etc…
I don’t believe that an obese child is at fault for being obese, it is the parents lack of teaching and guiding the child to make healthier choices. But at some point when a child turns into an adult, the responsibilities of their own health fall on the decisions they make. To all obese; if you consider yourself an adult, then take ownership of your behaviors and don’t blame others. Make changes to your life style that will reflect that of a skinny person.
“cells constantly scream to be fed as you continue to starve them, all while thinner people look on with pity or disgust.” This comment makes no sense. Thinner people don’t look on with pity or disgust, unless they are bullies. If an obese person feels this way, more than likely there is an underlining psychological issue and counseling would be beneficial.
In your 8 years of MT, you’ve never experience people just coming in for pain management? I would say about half of the non sports/deep tissue massages I perform are strictly to relieve pain from pulled muscles, muscles spasms and headaches. They are strictly there for pain and stress relief. They want a quick fix, and spend no additional effort to keep the pain away. If I can teach a client how continued MT is beneficial in one session, then I may have a clients for life.
Driving is a privilege, and not a right. Why make it easier for people that need to walk that extra block to get to where they are going. The cities/states/country are hindering the lazy and punishing the majority. The whole handicap sticker/tag system is a corrupt way for city officials to make money. Why not require public/handicap drop offs and valet systems. There are ways to promote jobs to assist the actual handicap. These comments I make are based from experience and knowledge. With 10 years experience as a LMT and 20 years caring for elderly and disabled family members, should give me a strong understanding.
By “official” standards, 20 lbs. overweight is considered “obese”, technically.
You keep referring to overweight people as “fat”…that just might be an indicator of your attitude toward overweight individuals; and quite possibly a reflection of how you are actually feeling about yourself in this overweight state.
Maybe the central and MORE IMPORTANT factor, in this particular circumstance of your practice, is that these individuals “don’t receive the same quality massage than I can give to a non-fat person”. Maybe you should refer them out to someone who could provide a quality massage for them.
Additionally; Why should they be paying MORE for LESS quality of service?
Is not an obese person described as fat? What about the term African American being called Black. It is much easier to type, and if you are offended by the word fat…than grow a thicker skin. I would understand if I used demeaning terms like Fatty, or Porker. But I’m not the type of person to bully individuals that are fat.
I worked with a trainer for 5 years and was told by him that despite my weight, I was one of his fittest clients. To the world that didn’t know me, i was overweight and by the numbered charts for insurance purposes, i was obese. I also am certified in various energy work modalities. The person on your table may not consciously know what you may be thinking of them BUT your energy is transferred to them when you place your hands on them, which is why I was taught to always ask a practitioner working on me what work they do for themselves. Through their hands, I do not want to receive their ‘stuff’ ,given the hard work it takes me to release my own.
It sounds like you have ‘stuff’ to work through about the overweight to get to the next level of your work.
Overweight people are highly sensitive generally, and can detect when someone is judging them- whether it being a higher cost for massage or paying more for clothes or anything really. One issue that can arise is when you have a large person accepting the punishment of being fat by not speaking up about discrimination, then the therapist who is discriminating against them is part of an abusive situation.
I’ve been both in my life: fit, slim, athletic, attractive AND fat, injured, out of shape and the “you have a pretty face” kind of attractive. I am very good at pegging people who don’t like me because my appearance doesn’t support their ideologies of a real human being.
Let me leave you with this-many years ago I had a skinny client that told me about her obese sister. She said that to the world, her sister had the problem with body issues but she knew that she herself obsessed, worried, and stressed about her body as much if not more than her sister did. Both had ‘stuff’ to work through but only one was judged.
Suggesting that it takes an extra dosage of expertise to manage a large person, therefore the price goes up is, frankly BS, as your level of expertise should be reflected by your hourly fee.
Just learn to be kind.
Just learn to be kind and feel it- s
I’m always looking to educate myself to reach a new level of mastering massage therapy. As far as the science of metabolism and how fat is stored and burned, someone with a doctorate in Exercise Science may consider my knowledge of this subject to be basic compared to theirs. But for someone that may only have a massage school understanding of anatomy may consider my education and experience as a very strong understanding on the subject. Some massage schools may consider my background as suitable to even teach the subjects to other prospective MTs.
I believe most over weight people are more judgmental on themselves, and maybe instinctively blame others or think skinny people are out to chastise them, because of their unresolved issues they harbor. Sometimes blatant remarks are taken offensively, even though there is a truth in the remarks. So in the works of the Fit Mom, “What’s your excuse?”
Mine is I that I work 12-14 hours in an office chair behind a computer. This needs to change before I become morbidly obese.
Linda’s comments are excellent and well thought out. Personally, having been both a massage practitioner and an obese person, I’d love to add my perspective.
A large person, whether obese, muscular or just built big may take more time and effort to treat, but with any client you tailor your massage to their needs and your own limitations. If more time is needed to do a full body massage, adjust the work to fit the time or find out if your client would like to pay for more time (or not pay but still go long, as my generous practitioner often does.) As an obese client, discussing my body size without judgment is perfectly fine. You may say that there might not be time to do all the requested treatment, but offer to focus more or less on whatever areas I wish.
Mostly, avoid taking a negative attitude toward your client’s body, since it is easily perceived by an obese person and is certainly not therapeutic. Your compassion for a person who walks through life encountering negativity based on body mass can be life changing for that person. Remember, it takes courage to expose an unclothed fat body on the table, and if you feel resentment for the person that will transfer into them, and add to the burden that society often delivers. Conversely, your acceptance and compassion will go far in healing more than just their physical complaints.
Seriously? So then do you start charging more for the 6’4″ guy or how about the “Arnold Swartzenager” guy? I mean who is going to feel comfortable and trusting going to someone that makes those choices about the body and related charges for bodywork? Diffinitely not the way I would work my business for sure. Don’t like working on her then perhaps there is a way to handle that differently.
How about treating the client as a person, and not a body type? Every case is different, and even from session to session, some clients will require more energy. The original question leads me to believe that the practitioner didn’t listen very closely when the ethics class was being taught. NCBTMB Article VIII specifically states we are not to unjustly discriminate against clients and/or health professionals. Point being, if you wouldn’t put on your price list “*prices vary, depending on client’s body type/weight/fitness level” you probably shouldn’t make it a part of your practice. If you find a certain client distasteful to work with, refer that client to someone who is more compassionate.
I’m completely offended by this attitude. I’ve had clients who have had massage therapists tell them they would “break the table” or would need to pay more for lotion since they were larger. Really? Do you also charge the client with incredibly dry skin more because they will need additional lotion? I agree with Linda you must ask yourself if you would charge a body builder or a pregnant woman more? Just because a client is larger do not assume they all want “deep tissue”. Often times, deep tissue is too painful.
I am a larger (yes obese) practitioner as well – by medical charts even severely obese. My size not only helps me work on clients but also feel less anxiety and not judged should they have an extra pound or even a hundred+. My table is wider than the standard (to avoid fear in turning over), nicely padded, and hydraulic so I am not sacrificing personal body mechanics while working on any body or using different techniques.
It is attitudes like that expressed above that kept me from getting massage for over 30 years. We ALL need massage. I’m thankful now to have met some amazing therapists who are passionate about their profession, love what they do, and help others without discriminating because of my size. If we want to be considered health care providers, we need to throw out the criticism and treat all clients/patients with respect. If you can’t do it…you can always refer out. Every client/patient deserves to feel comfortable & have a connection with a provider who is looking out for their best interests.
Thankyou!
I’m obese and I’ve been TERRIFIED to go for a massage… even though I know I need it! I don’t need deep tissue AT ALL- in fact the slightest pressure on some parts of my back cause extreme pain so if a massage therapist tried it I’d be out of there in thirty seconds. It’s partly to do with a pinched nerve in my lower spine… so massages would probably actually do SO MUCH GOOD to help my muscles relax and get things back into the right position, but there’s no way I can afford a $100 massage with someone who just feels disgusted with me.
Than why do I get charged more money at a salon because I have long hair? I know massage therapists are supposed to be this Mother Earth granola hippie dipper all you need is love type, but really we are human too. We spend our energy and money on lotions to try to give people what they need
Because it takes more time
I can’t believe I’m reading comments by LMTs who show prejudicial attitudes toward the obese. And yes, the negative comments are prejudicial and those who even think about charging a different fee schedule for the obese are prejudiced.
These LMTs would probably charge more for working with blacks or anybody else who was much different from them. I am totally ashamed of LMTs who have who even think with this negative view.
I had a client who was morbidly obese and shy to receive massage because of her weight. It compounded her apprehensions when she went to a local day spa on a gift certificate her husband bought for her. She made an appointment for a 60min Swedish and only got a 60min back rub. When she asked the therapist a bout what her expectations were, the LMT told her she was too big to be getting massage. I was appalled when she told me her story.
And if you have 2 different fee schedules and the client asks about it, you would lie about the difference, saying it was for further education? You’d have the same level of education for performing the same massage on someone size 2. That sounds like real ethical behaviour to me.
This is not about the size of the person. It is about your own preferences and maybe you should have a disclaimer “The Obese Need Not Apply”.
I like that “there is no judgment in this space.” People need somewhere to go where they are totally accepted for who they are and not judged, condemned, or discriminated against. Let’s assume they get enough of that in the real world – this space is safe!
There are many opinions and not all will be give the correct answer if charging more is inappropriate. What if the massage community took the perception of auto care shops. Should a mechanic change more for labor when spending twice the time repairing a specific part on more extensive design vehicle like a Ferrari than on an easier vehicle design on a Ford F150. It is not the therapists fault there are differences in the body types of their clients. In a perfect world every client a LMT works on is a 4’5 90lbs ballerina and the rate for 60 minute massage is $150. But this is not realistic and it is “Naive” to believe so.
Again I say, the person providing the service gets to choose what their rates are and if they want to charge additional fees. If I can bring in the business charging different rates to different size clients…or charge the same after spending less time because of more effort spent on bigger clients, then more power to me. There are many ways to increase your profit when having to work harder and longer. The effort I provide in my sessions is based on the individual client. Who’s to decide the appropriateness of charging the same rate when spending 90 minutes working on a 120 pound female dancer verse 60 minutes working on a 290 pound male athlete? Rates can be based on effort and experience.
And to the critics that are defending the clients and not their own LMT colleagues; We are massage therapists not a grief counselors. I Don’t sugar coat my responses to clients. If clients decisions based on their daily nutrition/health/fitness are affecting their weight negatively, then sometimes they need to hear it from a professional. As a male licensed massage therapist with a BS in Kinesiology/coaching I don’t pretend that it is ok for people to be obese, regardless of the client’s genetics or the decisions that brought them to the weight they are at. When I’m consulting with Obese clients, I give them my best knowledge and observations possible. I don’t try to spare their feelings. If I was I was in the field of psychology then I could discuss their mental state and dive deeper into their “fears and inabilities”. But to be honest – a fat person usually knows their fat, and unless they are in some psychologically denial trance, they don’t need a mirror to point that out they are fat. And any successful LMT probably has the common sense to not subject there “customers” to lewd comments about their extra weight. But my rates will still reflect the effort I have to provide when performing services….Period
A higher rate is warranted when a client’s medical conditions requires the therapist to have specialized training and skills. Common examples of this are pregnancy and cancer. “Anonymous” claims that it takes “extra finesse and energy” to work with an obese client. I believe that “Anonymous” is mistaken.
I worked with a client who weighed close to 400 pounds for over a year and have worked with many other clients of both genders who are clinically obese but not far outside the norm, as weight goes these days. Working with obese clients requires only acceptance of clients for who they are and adapting of techniques to achieve therapeutic objectives. This does not automatically translate to more “finesse and energy”.
What “Anonymous”‘s post tells me is that he or she may not have been exposed to a variety of clients in student clinic where supervisors could have provided feedback and suggestions about technique. It also tells me that “Anonymous” has some body image issues that he or she is allowing to affect his or her relationships with and treatment of clients.
Clients trust us to care for them with compassion and professionalism. On a deep level, as someone else has pointed out, clients “know” if they are being accepted or rejected. If a therapist doesn’t want to work on a client for ANY reason, the best course of action is usually to refer to another therapist. To accept the client’s money while silently creating a hostile environment and then UPCHARGING for the “privilege” of being treated by you is unethical and degrades our profession.
Extra work equals extra pay. Yes, big muscles are more work. All that ranting bunches entirely different ethical questions with a simple, in my opinion, nondiscriminatory issue. Yes I charge more for big people. No to all that other soapbox stuff. It just takes a lot more out of you.
Compassion.
No soapbox here: Charging extra based on weight, size or whatever your personal hang-ups are, is ethically wrong. It is discrimination. It shows ignorance and poor character. Our jobs aren’t merely to rub or tape or apply lotion for a paycheck. We are business owners who practice edification and build relationships with our clients. We take pride in ourselves, our place of business, our education, our work and yes, our clients. As smart, well-trained and ethical professionals, we offer excellent customer service by providing a safe and accepting environment for all clients. If this is not part of your business practice or your personal paradigm, then maybe massage & bodywork isn’t for you.
Wow. I’m shocked and disgusted by this! I’m not a massage therapist, but I’m a part time receptionist at a holistic health center and I’ve never heard any of the therapists I work with complain about working on obese people. You charge for your services NOT for the weight of the client!
So, here’s my question to everyone who agrees with this article; would you charge a thin person less for a service? Fair is fair. If you charge an obese person $10 more than your price of $50, then a thin person should be charged $40.
Unbelievable!
I think it is OK to charge more if you are doing additional work such as taping (where you would charge for materials used) or additional modalites not included in a standard massage session, but to charge more simply due to the fact that the client is obese is discriminatory pure and simple. If you do not wish to work with a particular client because you feel it is too hard on you, then by all means refer them to another therapist who surely would be happy to get the work. You can also say you are not taking any new clients right now.
Linda, you are right on, the one charging more for obesity should have her license revoked, obviously her judgment of people are getting in the way of ethics and consideration for another person. Heavier people are the ones that need it the most. Therapist are to help, not hurt someone and if you are charging more, than you already think less of this person and it will show in your hands and response to her. I am very disappointed in this article. This is the kind of thing to make people turn away from help because of selfish, inconsiderate people like this.
I’m amazed by this discussion. I honestly don’t see why obesity makes a massage so much harder than working with a skinny person. I could make the case for the opposite . . . but it’s really not important. If you really are charging extra for advanced techniques, that’s fine, if you do the same for everyone, and your price schedule is clear, and clients have the choice. Some people of every size just want a simple Swedish massage; some people of every size want a more therapeutic treatment. No matter how big the person, you figure out what s/he likes and do that (within the limits of ethicality and your own boundaries).
The problem with making assumptions about fat people (eg, no self-discipline, low self-esteem, etc) is that thin people have the same problems, but we don’t necessarily see them; and while those assumptions may be true, they may well be completely untrue. We think we know because of what we can see; but there’s always much more to a person than what we see on the outside. Hard to believe this isn’t obvious to those who work so intimately with people as massage therapists.
But hey, if you drive your bigger clients away by not respecting them, charging them more because of their size, making assumptions about their lifestyle, thinking all the time you’re working with them about how much extra work you’re doing for this person who is doing nothing but lying on your table being fat, I guess that’s fine with me, because I am always happy to take clients who are unsatisfied with their previous therapist. Thanks.
In school, I remember hearing about a place that charged clients by the pound. Less for lighter, more for heavier people. I remember feeling funny about that. But having done over 7000 massages, I realize that we should charge more for more effort on our parts. We often charge extra for deep tissue. That’s one way to look at it. On the other hand, I don’t usually find that obese people take more pressure than others because the adipose tissue makes it painful for them.
So many therapists complain about not having enough clients– could this be a cause? I did several massages on a prominent actor – he was black, 6-foot-six and very large and muscular. He thanked me for doing “real” massages. He said when he was less known he often got what he sensed were “deliberately bad” massages from therapists who did not want to expend any energy on him perhaps because of his size – or perhaps because of his skin color. Or both. How sad.
A massage therapy session is the one place that any person should experience acceptance and respect of their body. Overweight people are constantly judged in our society; to charge them different rates is another expression of discrimination.
Would you charge more for the needy client that talks your ear off after the session? How about the person who often cancels and reschedules? A higher rate for the stiff marathon runner who never stretches? Some clients will be more challenging than others, and this has nothing to do with body type.
Very well said and very good points. For me the clients I would like to charge more are the ones who present with extremely tight muscles that are “full on” to work on. Then, instead of having a few massage treatments regularly they leave it for months, don’t stretch, don’t drink water and turn up in the same condition each time wanting to be “fixed” !!!!!!!!
All the others, regardless of size, I just adapt massage to fit into the time they would like.
Fees .. for LABOR (exerted) . I personally find working on extremely tense, dense, immovable muscles that tax my thumb joints way worse; since most of MY overweight clients are more sensitive to extreme pressure. And I make my clients FULLY aware of what I do .. AND WHAT THEIR PART is in their heath and recovery = limited expectations. Most people I have are dehydrated, no nutrients, or exercise, or stretching … they know it’s there fault !! and have reasonable expectations of relief.
I have 3 basic fee ranges. “Traditional” relaxation (light work , elderly and fibro ect) $60 hr. Signature massage (moderate to firm pressure relaxation) $70 hr. “Focused”, deeper pressure or specialized at $75 hr. I know if I expect deeper pressure or skilled such as rolfing when I get a treatment.. I pay more.
No. Absolutely not. I would never discriminate a client by their size. If I were limited in my skill and energy to effectively treat the client I would explain to them my limitations, tell them I want them to receive optimal care and refer them to another therapist who I trusted could do a better job than I could. I completely disagree that an obese person is more difficult to assess and treat, it just takes a special approach, one that cares for the client, is warm, understanding and communicative. I really feel like the therapist in the above article is prejudiced against larger clients or is unwilling to admit they are not skilled enough to work with a diverse group of clients.
Great comments on this issue! As a massage therapist I would never charge anyone more or less because of their weight. If I was a client and found that my massage therapist was charging more, I would change therapists. In massage school we learn in class, and in clinics, how to work effectively on all body types, and yes, some are more challenging than others. Personally, I found very muscular individuals much more difficult to work on that those with some extra body fat. Thanks so much for all your feedback.
I think MANY things can make one massage more difficult or challenging to give, over another… not just “obesity”.
I think it is important to know that wherever and wherever we “give” in life, IT DOES ALL COME BACK TO US. 🙂
That $10. is NOT worth the hurt and offense that could EASILY be experienced by any particular individual in these situations or conditions.
We should maintain sensitivity, and have confidence that we
WILL receive our rightful rewards, in due time! <3
Love, Peace, and Healing
Sylvana, Holistic Massage Therapist,
Transcendence Massage Ventura, CA
I charge more for deep tissue. If a client needs nmt or another advanced modality or if the clients expectation is not being met through relaxation massage I charge more. These techniques cause more wear and tear on my body and I have to protect myself as well as my client. If I am unable to go as deep as they want I communicate that. We do work deep when going through adipose or hypertrophic muscle. I don’t believe that it is a matter of discrimination if you aren’t viewing the person negatively or treating them with prejudice. I have hurt myself trying to go deep on many populations and do charge extra. It is important to be honest and fair in our communication with and thoughts about our clients. If you cant help them tell them so. Be fair and post your prices.
Obviously you don’t know nor practice proper body mechanics. If you can sleep at night with your attitude, then I guess it works for you. I charge by hours, not size. I’ve learned about many different types of bodies in my 11 years of practice. It is often the challenging clients who will teach you valuable lessons, such as how do I position my body to help him/her without injuring myself using leverage and gravity? If I position my body right, it’s like going to the gym, so it benefits my body. Since you absolutely believe that you should charge more for fat people, well you should be truthful in your policy clearly stating that is what you do, instead of hiding it in “I applied more specialized technique” BS. Go ahead and tape the sign to the door, “I charge more for fat people”. See how much longer you will have ANY business. I think even skinny people will be turned off by your attitude, AND they (skinny people) are absolutely entitled to $10 discount. Hope you have a good liability insurance, because you’ll be sued sooner than later.
I have also been obese and have no prejudice toward anyone. If I am uncomfortable with a client it is in response to something inappropriate they have said or done and never based on physical appearance. There is beauty in everyone. To not be able to see that is unfortunate.
I didn’t view this therapists comment as derogatory. I have people say “you can go as deep as you want.” I say, “would you like to try my deep tissue? It is more therapeutic in nature.” If not I continue the “relaxation massage.” That is light to moderate gliding effleurage, pettrissage and some heat therapy if indicated. We do have a right to offer what we offer for a price that reflects our skills,abilities, advanced training and exertion.
I actually charged less, I felt there was so much on the clients plate that I could lessen that by allowing affordable , compassionate care. They got helped, I learned, we all benefitted. The paycheck is the smallest part of my profession, and compassion is such a gift to share.
I am offended that this is even a topic! any body on my table is the most perfect body, and should be honored, celebrated and offered the best service….period!! May I also add that charging extra for K-Tape is a whole different ball game, and I hope you are trained and certified to be taping, or you could do as much damage to your clients muscles as you do to their spirit. Shame on you
Obese clients often are easier to work on because adipose tissue can be very soft an pliable, allowing deeper work much easier than a body builder. Often the only difficulty is when the work requires me to lift a larger limb, yet the same difficulty is required with very tall and or muscular clients.
I have the option of charging a client more for a higher level of work, whether skill or effort, but that is across the board. In fact a very tiny client asked if I charge more for “super sized” clients. I told her, “if that were a consideration, little clients could be charged more, as they get more strokes per inch”. We both laughed.
By the way. I’m a rather super sized individual, sometimes more super than others. And I work hard to make clients comfortable whatever their circumstances.
1. Contractors charge more to cut down larger trees compared to smaller trees. The size of a tree can determine the amount of labor that is required and how long and difficult it will take to cut down.
2. I’ve also checked and auto detailers and most of them charge different rates to clean different size vehicles.
I still think it is ethically ok to charge different rates for people of different weight, or give different amounts of effort. Let’s be honest – Therapists don’t want a clientele of unhealthy people. So Obese people coming in for massage usually are just looking to relax, not for therapeutical reasons. Athletes and extreme fitness buffs already expect to spend more for their training needs.
Personally I feel if I have to lift a 40lbs limb compared to a 20lbs limb, The amount of effort if give will be taken into consideration when I perform the massage. This may be based on the fee I charge and how often the client returns or the referrals they provide. If a 300 pound body builder wants me to give the same pressure massage as I would give a 90 pound ballerina then he is probably going to have to pay more, see me monthly, or provide me some successful “word of mouth” advertising. for those that disagree are more than welcome to their opinions and massage rates.
I would also like to add that this article is very general in how it asks the question, “to charge more or not to charge more?”. There are more ways than one to charge for the labor a therapists provides. As soon as my client walks through my door I’m surveying their posture and structure, asking questions about their pain or needs. When my client asks me what my rates are, I tell them I charge by the session and it can last between 60-90 minutes. I know what my technique and strength is, and depending on how difficult the client is to work on will depend on how long the session is and how much strength I put into it. If the client asks me to go deeper, then I may work less on the harder body parts. If the client expects more from the massage than what they are paying for, more than likely I don’t want to see that client a second time, and I just collect my service and I wish them well. If the client is a pleasure to work on, I may spend a little extra attention on the areas they request, typically the neck, shoulders and back. This is my profession, and I’m not a volunteer. I enjoy being a massage therapist, and I specialize in working on athletes with sports and deep tissue massage. I tend to tell obese people, if they are looking for a relaxation massage, then go to a spa. Spas specialize in relaxation. If an obese person is trying to lose weight and wants to visit an LMT like me, then they can pay for the costs of their training.
There are a lot of prejudices people have towards obese people. But again, we work to earn a living and hopefully enough to retire some day. I do believe in donating/helping towards a worthy cause, but my practice and experience is my livelihood. I’m not going to put wear and tear on my body without being compensated for my efforts. If an obese person can afford or choose to live an unhealthy life then an obese person can be held accounted for any repercussions that occur from being obese. Take this as a fact…you can’t massage fat away. A massage therapist does not help obese people lose fat. Being obese is a choice, because an obese person chooses not to exercise, eat unhealthy foods, eat more calories than which they burn, or blame others for their poor unhealthy choices. It is fairly compared to being prejudice to an alcoholic that drinks and drives. I do understand that there are factors that drive individuals to become obese…I live with some of the same work related stresses, and my escape is to eat a large dinner, drink a beer and watch 3 hours of TV after work and before I go to bed. I indulge my self with fried and fatty foods, when I should eat more veggies and fruits throughout the day. I drink more soda that water. I don’t exercise, and when I do exercise I end up being to lazy to continue the following days and I revert back to my unhealthy pattern.
Hopefully someone reads this and gets a kick out of it. Or maybe it sparks another debate =)
I agree with Anonymous. I worked as massage therapist for 13 years before becoming a registered nurse. It’s not a matter of passing judgement on an obese client. It is a matter of the massage therapist’s work being doubled, tripled or even quadrupled during one session. It’s a fact: working on obese people, especially those who request deep tissue, can be exhausting. Obese people tend to have a thick, hard layer of adipose tissue that makes it nearly impossible to access underlying muscle tissue.The majority of the obese clients that I saw complained of knee pain or lower back pain, and were seeming in denial of the fact that that their pain was a direct result of too much weight bearing on their joints. There is no amount of massage that can relieve that kind of pain. You need to lose weight! Massage therapists are taught to educate their clients on how to relax and relieve pain. Unfortunately, society doesn’t think that it is acceptable to for a massage therapist to state the reality of the situation and tell a client that their pain is likely a result of their weight, so we have to be nice and pretend that we can do something about it. Although I knew that my attempts in relieving their pain were futile, I worked my but off on them. And I say that literally! When I began my full-time massage practice, I automatically dropped 10 lbs. As a massage therapist, I had a busy and successful practice. Some of my regular clients were obese and I gave them the same attention and care that I gave to anyone else. I did not, however, have the option to charge them more because I worked on commission and did not dictate the price of my services. Over the years, I’ve had the pleasure of meeting many massage therapists. Not one of them will ever HONESTLY tell you that it’s not more of a physical challenge working on larger clients. In a fair world massage therapists would get paid more to work on obese people, but unfortunately, life isn’t fair:) One of reasons that I chose to go to nursing school is that my body simply could not take a full-time massage practice after 10 years. Massage therapists are over-worked and underpaid. Obese people make our jobs harder. Plain and simple.
I have a feeling that fat people supporting people here are either not massage therapists at all or just obese massage therapists themselves. What are you talking about, how you can potentially compare working on obese people and skinny people. When you have an obese person you absolutely HAVE to adjust the table height just for this particular person no matter what kind of a massage they are ordering, this is an extra thing when you work in a facility with the tables where you have to adjust the height manually, you have to modify and alter a lot of strokes and replace tons of strokes that you simply unable to perform on an obese person, use your legs, destroy your back lifting their arms and legs and did I forget to mention the fact that lifting their leg is like lifting a 10 yo kid’s entire body, I feel like I worked on 3-5 height-weight proportionate people after working on 1 obese person, the funny thing is that these people don’t even think that they should be tipping extra for the MT work, they think it is ok to give an average tip or even below as they had received one massage 10 years ago when they still looked human and that other MT stretched them a lot and actually managed to reach their muscles at that time and today they just don’t feel like that anymore and it doesn’t even come to their mind that it is their and not your fault, they don’t realize how how hard it is to work on them not even mentioning the fact it is simply disgusting to observe the body that looks like that for one hour or even more. Because this is a body of a lazy person. And don’t mention the fact that these people are sick and have diseases. I have lived in several countries and how come that people in other countries look so much slimmer, they have different diseases and different anatomy and physiology or something? That is sick
I had to turn a client away because she weighed more than what my table could handle. Yes it takes more energy to press through all the fat to get to the muscle. If they want deep pressure they need to realize if takes a lot more energy. Also if an obese person smells and is sweaty it’s more unpleasant to work with them. I get charged an extra fee for long hair when I get my hair done so yes, I charge more for the extra energy and cream I have to use on a fat person. They need to get over it.
Maybe I should become a massage therapist, I could profit from the prejudice of that attitude.. Personally, I love the feel of plump skin. To me, that extra “give” to the skin is much more pleasurable to touch than the feel of skin bound tightly over the skeleton. However, and this is where my lack of expertise shows, I would worry more about working on a hirsute person, pulling their hairs during the massage.
I want to specialize in massage for obese patients. I am talking 500 plus pounds. BECAUSE this group of people need to be touched, they need the bodywork, they need a judgment free space. They know they are big. They know they will need special accomodations at times. Often they have medical issues that go along with their weight issue. So yes, charging additional may be appropriate if more TIME is spent with the client. They will need more time getting on and off the table, or most often, it may be a special mat on the floor. I always bill for my time, not for the size of the client. This keeps it fair and ethical.