Fat 101: Must-Know Anatomy for Massage Therapists

Our culture’s got a big “fat problem” (and it’s not the global obesity epidemic). Fat is among the body’s most vilified and ignored tissues. Yet, as bodyworkers, it’s one of the tissues we manipulate the most in all our clients, regardless of body size. Whether you use more superficial modalities or your intentions run to deeper tissues, fat is right under your hands in every single massage. But how much have you been taught about fat as a tissue? Probably not a lot, which is understandable because a lot is still being discovered. Research from the past few decades is rewriting the story of fat tissue as a major endocrine organ, essential to human health, and a fascinating part of the fascial system that we massage every day. It’s time for a re-introduction to fat: Fat 101.

THE BIG “FAT PROBLEM”

When fat is given attention, its importance is summarily reduced to this question: “How much fat is there?” (frequently followed up with: “How do we get rid of it?”). This disavowal permeates every level of our culture and has dangerously made its way into healthcare. While weight bias among medical professionals is starting to get some long-overdue attention, the problem runs deeper than clinical interactions — so deep that it’s embedded in our understanding of fat tissue itself in human anatomy and physiology.

A recent study on weight stigma in medical training offers a glimpse into how this is playing out in medical school anatomy labs. In one setting, medical students routinely complained about “difficult” larger-sized donor bodies (cadavers). The students resented dealing with all the fat before, in their words, “getting to the real anatomy.” It's tempting to shake our heads at the weight bias running rampant in these anatomy classes, but the reports reveal another bias that goes beyond size. An accompanying fat bias shaped their views about what tissues count as "real" anatomy. What does that even mean: real anatomy? Clearly, fat didn't make their list.

What happens, though, if we shift the focus and put aside our culture’s insidious obsession with “how much fat” and instead get curious about fat as normal and essential anatomy in all bodies? As it turns out, fat is fascinating, dynamic, and complex.

CURIOUS MASSAGE THERAPISTS

What would it be like to encounter fat in the dissection lab in a setting where curiosity can flow — without the pressure of exams, no preset curriculum, ample time to explore, and from the perspective of massage therapists?

Let’s imagine for a moment that we’ve joined a group of curious massage therapists in the dissection lab. Carefully observing, we make our way through the skin's epidermis and dermis. Passing through the skin, bright yellow fat tissue appears. Full of plump, round lobules, the fat is striking in color and quite distinct from the densely packed dermis above and the tougher deep fascia below. While many of us haven’t seen fat lobules uncovered, their texture is perhaps familiar to us as the dimpling of cellulite on our own or our clients’ bodies.  

As this sea of yellow first comes into view, we reflect on how those medical students wanted to get past the fat to the “real anatomy.” Fat is easy to dismiss as a bunch of blobs, while the muscles and deep fascia beckon to us from below. But when we pause and get curious as massage therapists, all sorts of new questions come up: What happens to the fat when we put pressure on it, squeeze it, and massage it? How does the fat move under our hands? Can we feel its texture through the skin? How do we access deeper tissues through the fat? Does the fat make muscles feel softer or bigger than they really are?

Perhaps more foundational questions would emerge: What is fat, really? And what’s it doing here under the skin? 

Want to read more? Head to the July/August 2024 Massage & Bodywork Magazine and read the full feature article for free.