"Weight Alone Is Not An Accurate Measure of Health" with Mara Levy

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More about my guest:
Mara Levy MSOT, OTR/L, CLT-LANA, SEP  is an occupational therapist blending somatic therapy and lymphatic drainage to bring body-based mental health care and trauma-informed bodywork. Mara has been an OT since 2005, practicing as a certified lymphatic therapist since 2013, and is a somatic experiencing practitioner since 2024. Their approach is neurodiversity affirming, fat positive and HAES-aligned, queer and trans affirming, antiracist, and liberation-minded. They can be found at their private practice Rainbow Spring Wellness at www.rainbowspringwellness.com

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Transcript

Lindsey Vestal New and seasoned OTAs are finding their calling in Pelvic health. After all, what's more ADL than sex, peeing and poop? But here's the question What does it take to become a successful, fulfilled and thriving OT in Pelvic health? How do you go from beginner to seasons and everything in between? Those are the questions and this podcast will give you the answers. We are inspired OTAs, we are out of the box OTAs, we are Pelvic health OTAs. I'm your host Lindsey Vestal and welcome to the Otis and Pelvic health Podcast.  

Lindsey Vestal My guest today is Mara Levy. 

Lindsey Vestal Who is a occupational therapist, blending somatic therapy and lymphatic drainage to bring body based mental health care and trauma informed body work. Mara has been in O.T. since 2005, practicing as a certified lymphatic therapist since 2013 and a somatic experiencing practitioner since 2024.   Their approach is neurodiversity affirming, fat, positive aligned queer and trans affirming anti racial and liberation minded. They can be found.  

Lindsey Vestal At their private practice. Spring wellness. W w w rainbow Spring wellness.com. Let's get into today's conversation. Mara, I am honored, so honored that you could be a guest on the Notes for Pelvic health podcast. Thank you so much for joining me. 

MaraI am so happy to be here. Lindsey Thank you so much for inviting me. 

Lindsey Vestal We got to know each other a little bit more Last year when you were one of our faculty members for the Trauma informed Pelvic health certification and you gave an incredible talk on body neutrality and body positivity. And I thought, you know, these these practitioners, we're so lucky to have you that I thought I would love to get you back on a larger platform like my podcast, because I just think this is information we are not sharing widely enough and the conversations need to be happening more and more. So again, thanks for thanks for taking the time to chat with me today. 

Mara As something of an activist, I am thrilled to be able to talk to will help to a larger platform. 

Lindsey Vestal Fantastic. I think I would just love to start it off with something just very basic and and if you will humor me, would you mind defining what body neutral care is? 

Mara Levy Absolutely. I think that the biggest thing to remember with body neutral care is that whether someone is large or small, fat or thin. They all have a body and the care they get should be essentially the same. If someone's leg is not more or less broken, no matter what their body size, everybody has a pelvic floor. So it's not giving one standard of care to then people and just telling fat people to lose weight and come back later. 

Lindsey Vestal There's so much there to unpack. But I think you said it in the most succinct way possible. And I know we're going to get into all of those things today. So. But that was that was just that was buttoned up. Thank you. That was that was perfect. I'm so curious as to your thoughts on how do you think societal pressures around body image end up impacting our clients who are coming to see us for their pelvic health concerns? 

Mara Levy It's so and it impacts them so hard. We have so many cultural assumptions about fat and fat bodies in our country, just to the even the extent that my using the word fat and fat bodies is probably something some people find, you know, very pro clutching. And I use the word very intentionally because it is a body descriptor, just like tall or blond. So even just the assumption that fat is scary, that fat is not something you talk about in polite company. Can be impacting folks. And then the assumptions we have about people with fat bodies that they're fat is bad or dangerous, that fat bodies are gross or ugly, that fatness is something that you kind of is a choice. You could have worked harder if only you had worked harder, done better, taking better care of yourself, or that it's related to being lazy and also related that it's something shameful to be fat. And that is just assumptions that are swimming in our cultural soup. I think all of them are completely wrong. So people who have fat bodies are swimming in the same cultural soup and end up with internalized weight bias where they are turning all of that bias against themselves in their own body. Studies have found that of people with high BMI, which is its own conversation that I can go off on for as much time as you want me to. Half of the people with higher BMI have that internalized weight bias. And that affects people in general. It affects their occupational involvement and affects their quality of life, and it affects their willingness to come to a health care appointment. Because when you are afraid that your body isn't worth care, when you are afraid that your health care professional is going to treat you badly. I have friends who have a panic attack every time they have to go to the doctor because of their past experiences. So all of that keeps them out of the pelvic floor office where they could get so much. Not to mention the assumptions that the problems people often come to the pelvic floor for. That's just because they're fat. So they assume that they can't be helped by anything other than losing weight. 

Lindsey Vestal Yeah. Speaking of people avoiding care. What are some simple things that anyone listening to this podcast can do in their treatment rooms on their website? You know, the ways that people find find us and then when they first walk into our space, what are some of those classic things that come to mind to you that we can do to help everyone feel more welcome? 

Mara Levy Absolutely. I mean, of course, the first step is working on our own biases so that we're not perpetuating weight bias in our care and in our treatment. So if we're not doing that, that's the first thing. So that once people see that the office is safe, they actually receive the experience we're promising. But if we know that we can do that in our marketing, being clear that we are body neutral, size neutral, I go a step further and say that I'm fat positive in my marketing because that's something that I'm particularly passionate about and that's in all of my blurbs on my web page and my Google business profile, etc.. And then also in my website, I try to make sure I include photos of people of various sizes so that I'm not just saying I'm fat positive, but I'm living that. So I work really hard in my stock photos to find fat bodies as well as bodies of other races, other sizes, other genders to try to make sure that my website reflects what I believe and who I am. And then once people get into the office, how can we make that a safe and inclusive space for them? One of the big things is does the office fit their bodies in the waiting room? Are the chairs wide enough? Are the armrests far enough apart? You know, I'm a middle mid-cap person myself, and half the restaurants I go to are pinching my butt the whole time. It's really unpleasant. And if I see that in a doctor's office, if I'm feeling trapped in a chair, that's not going to put me in a position of feeling safe by the time I get back into the clinic. And then also, as we choose our clinic, furniture. Furniture, are our treatment tables wide enough? Is the weight capacity of our tables? Good enough? So I've been recently pricing out electric tables for electric high low and discovering that some of them have a weight capacity of 250. That's that's less than me. And that's definitely not nearly enough to accommodate my super fat clients. So finding I say 500 pound is my absolute minimum and I would prefer a 6 or 700 pound maximum for my furniture. But if it's less than 500, I won't even buy it. Like, that's just not that's not my table. That's not my chair. Some of the other things that we can do are also paying attention to anything that goes on. The client's body that has a size blood pressure. Cuffs are a really important one because you actually get an inaccurate reading. If the blood pressure cuff is too small for someone, it will show them as having a higher blood pressure than they do, which considering that we have all this fat bias of assuming that, of course they have high blood pressure, we're not even going to realize that that's an error. So making sure we have blood pressure cuffs that fit a variety of size arms if we have gowns as part of our treatment. Does the gown fit your client? There is nothing worse than sitting here in a gown that doesn't cover my shoulders where I'm just cover draping it over my body, where a thin person would have this comfortable coverage that allows them to feel safe. So that's something that we're offering. Make sure we're offering it in a wide range of sizes. So those are some of the big things that we can do. 

Lindsey Vestal I remember you saying in our common forum Pelvic health certification, if you can't find, let's just use the example of a chair, for example. Just don't get it. Get a chair with armrests. Right. And I thought, brilliant. It's just it's such a it's such a basic thing that if someone had told me before I was buying anything, it's like, this is a no brainer. Of course I'm going to consider these things. And so I really appreciate I really appreciate this conversation. Do you have any sources for or good places or even companies to refer to for finding furniture, reliable resources such as, you know, making sure it's at least 500 pounds and above? 

Mara Levy I mean, really, you need to look at the you need to look at the fine print. Yeah. It's going to be in any reputable company is going to have their weight capacities. The electric tables will have their. Sitting wait capacity as well as their high, low weight capacity. I've had good luck with Earth Light in terms of massage tables since that's what I use in my practice. 

Lindsey Vestal Okay. Excellent. That's that's perfect. You mentioned a really important thing, which I appreciate so much, this idea of checking our own biases. Are there any resources, websites, books, any places you can point us to so that we can pause and take a check? You know, at the time of this recording, it's it's the new year. You know, it's January and it's a time when people tend to be a little bit more self-reflective. And I I'm just curious if there are any places that we can go to to start to do that internal work. 

Mara Levy There are so many places that I have trouble thinking of them as here because just like, well, you could go to this person and this person and this person, you know, there's body image with Bree is looking at body grief, the grief of your body being larger than you want. A person who was really key to my journey was Raegan Chastain, who is very focused on weight bias in health care. She is more focused on. Serving fat people that I'm serving, the health care providers who serve them. But it certainly gives you a great way to see what we do and how that affects our clients. And some of what I recommend is just make sure your social media feeds help with your bias. A lot of us don't eat. We don't even see fat bodies as anything except patients as anything except something pathologizing. You know, when we watch TV, it's the fat bodies are always the ones that are sloppy and eating something that drips. They're the people. They're never the people that you admire for how beautiful they are. And not seeing fat bodies as beautiful is. That's a cultural training thing. That is not something that is inherent to the inherent to the human experience. So if we can be trained to only see thin bodies as beautiful, we can retrain ourselves to see fat bodies as beautiful, too. And so much of that is just exposure. Curating your Instagram feed, curating your Tik tok feed, and just searching for fat positivity. 

Lindsey Vestal Yeah. Yeah. You mentioned a couple of myths earlier, and I'm sure there are so many of them. But for example, one I'm referring to is like, you know that fat people, if they just worked a little bit harder, you know, they could lose weight, for example. Could you break down one of those myths for us? One of the ones it doesn't have to be the one I just mentioned, but one of the ones that you find so pervasive and relevant to us as health care providers. So that. We can understand a little bit more of what perhaps where our growing may need to lie, where we can challenge some of those those beliefs that we may know inside isn't true. But let's I would love to hear your take on that. 

Mara Levy My. I have three main myths that I think are so important for professionals to think about or one. 

Lindsey Vestal That I get. Three, I love it. 

Mara Levy And really, they're just assumptions that I would say yes. One assumption that is so common in our culture is that being fat causes poor health. That there is a cause and effect relationship between them. And I am really not convinced that it's causation, not correlation. Because there are. Fatness increases inflammation markers, but also stigma increases inflammation markers. Living in a world that doesn't treat you well, receiving poor health care. And they do receive worse health care. All of those also affect that idea. And there's even something they call the obesity paradox, which is that people who are overweight will still, quote, overweight on the BMI scale, which, as I said, is a terrible skill and terrible metric. People who are overweight actually live longer than people who are underweight. So, you know, Ariana Grande and Wicked is probably less healthy metabolically and in terms of a risk actuarial chart than I am. 

Lindsey Vestal I don't think anyone would ever think that. You know what I mean? It's like this is why we're having this conversation. Tell me more. 

Mara Levy Absolutely. So, yeah, that also ties into just the BMI was never designed to measure our health. It was measured. It was designed to measure populations and it was normed on white men with desk jobs. So it's not even normed on the entire population. So that's one of them. And I can go into tons more detail. But really, I would just say. Question that assumption, question that link and research it. Another one is that if it does cause poor health. So even if we assume that that myth is correct, the fact does cause poor health. Is weight loss, the solution to which we would all say, of course it is. But there's actually not a ton of evidence of aid to be. It tends to be fat people versus then people. Not so that people who became fed and then how healthy they are. And part of that also is that weight loss is not really very well in our control. And there are it's very difficult to lose enough weight to make a statistical difference. You know, 5 pounds, what difference is that going to make in a gross general health risk kind of way? And I have found so few studies that actually study past a year or two when it's within 4 or 5 years that most people regain most all or even more of the weight. And granted, that's not looking at like the new drugs like example. But I was doing some quick Googling before our meeting today trying to find the long term effects of those impact. And there wasn't anything past two years. So what happens five years later? Who knows? Is it still going to be effective that. And then also, there are risks associated with weight loss. There's the mental health risks like eating disorders. There's also no real significant change in mortality for young adults changing from obese to not obese. There is. Conflicting evidence on risk of major cardiovascular events. There's a higher mortality risk for older adults who did change from, quote, obese to, quote, not obese. So it's really not necessarily making us healthier. And then, of course, even if weight loss is the solution to something that is a real problem, does it make a difference if we as health care providers are encouraging weight loss? Because there is not a single person in this country who has not heard the message that you're supposed to try to lose weight. It's not like they don't know that that's the cultural message and it can encourage more internalized weight bias. It can really retraumatize them. Also, we all really know what works. So do we have any actual suggestions that help more than they harm? And in terms of what authorities could prescribe and recommend, you know, how do you know that they're not already eating very well and exercising well? You can't just say, go exercise and eat well, okay, I am now. What? So that's a couple of the myths that I like to get into. 

Lindsey Vestal Thank you so much. And you had touched on this a little bit earlier when you were talking about using the term fat as a body descriptor. Like my hair is brown, right? My eyes are blue. Are there any other language or common phrases that we as Okies, as Pelvic health Oats might use that you could think of, that we should also be be particularly aware of thinking about considering in our treatment rooms? 

Mara Levy You know, I don't have actually anything specific that comes to mind. I must admit I'm not a public health practitioner. I'm a lymphedema and mental health practitioner. So a lymphatic and mental health. 

Lindsey Vestal It doesn't have to be specific to pelvic health just, you know, in in your journey. And as you know, we have people who are potentially hearing this information for the first time on this podcast. Just, you know, we know words matter. So just wondering if there's anything else that kind of comes to your brain besides thinking about the word fat as a body descriptor. 

Mara Levy Yeah. I think something to keep in mind is are the words you're using pathologizing the condition? When we say things like overweight, that's over. What? Over overweight or obese is very much a medicalized mythologized word that I find way more offensive than fat. And everyone has their own words that they feel comfortable with. Some people absolutely do not want their body called fat, in which case client centered care. You don't use that word. They might prefer Fluffy or they might prefer curvy or they might prefer. Yeah, there's a million things. So really making sure we're following our client's lead in the word choices that we have. And then another one that we are going to think about is if you have anything that you want to ask about weight or body size, make sure you're thinking about why you need that information. Make sure. Why do I need to know your weight? Yeah. Why do I need to know your BMI? Is there a medical reason that this is useful to me? And if there is a medical reason why this is useful to me, like I need to know this because I'm recommending a shower chair for you and I want to make sure it fits. Make sure you explain. This is why I need that information, because we want to make sure we get the right size. Also really clarifying recommendations that are general to everyone with a body. You know, if I'm going to tell somebody to exercise more, I always try to contextualize it with and everybody could probably use to exercise more. You know, having good cardiovascular fitness is good for all bodies. So that the things that are commonly recommended for higher weight people, they know that this is a standard recommendation. This is not. I think you're fat, and therefore I'm telling you this. And also just knowing what our clients are already doing before we try to suggest anything. Yeah. I have one friend who walks 3 to 5 miles every single day on these that are probably going to be needing replacing soon, and then their health care providers tell them to lose weight or to exercise more in order to lose weight. And like, how much more exercise do you want to do? 

Lindsey Vestal You're exactly right. I mean, just starting with tell me a little bit about your routines. Right? Like, what is your day? That is just so it is. It is. It's almost humorous how basic that is. Yet are we doing it? And so this is exactly this is this conversation is so illuminating because I think it's doing a little bit of a task analysis on ourselves, a little bit of task analysis regarding our approaches on our assumptions. 

Mara Levy Absolutely. And yeah. O.T ourselves. Why not? Do we know how to do this? And also, I tell my patients, O.T. is as a profession is telling people what's common sense that they never thought of. This is the same thing. 

Lindsey Vestal Yes, exactly right. What changes would you like to see the health care industry shift to in order to better support body neutral or positive approaches that maybe we haven't already discussed today? 

Mara Levy I mean, some of the biggest things are just being accessible to everyone is if we're talking larger health care. That is huge. I also hate weight cutoffs with a blinding passion. I worked for a long time in a system where you couldn't get a hip replacement above a certain weight. You couldn't get a knee replacement above a certain weight. And the evidence even is not supportive of that. You know, and they'll use the analysis that, you know, surgery is higher risk, but they'll put them under for weight loss surgery in a heartbeat. So really thinking, I think the biggest thing that we need to do, actually, is remember that weight is not an accurate measurement of health. That is the biggest thing. I cannot look at a person and know anything about how healthy they are, about how well they take care of themselves, about how they eat, about how they exercise. About whether or not they're going to follow my recommendations. I cannot tell any of that by looking at them. So we have to look at the metrics. We have to look at. How far can you walk before you're out of breath? How easily can you stand up and sit down? Can you go up the stairs comfortably? You know, all of these things that we say, it's weight. Is it because there's very few problems that fat people have and thin people never have? So I think the other thing for health care providers to keep in mind, if you're tempted to dismiss somebody because of their weight, is mentally subtract a couple of hundred pounds. And if this person was thin and had the exact same presentation, what would I tell them? What would I offer them? And then maybe you should do that. 

Lindsey Vestal Yeah. Yeah. Are there any you know, you mentioned a couple I g and, and social media people that that have greatly influenced you. Is there is there anyone else that comes to mind? Any resource? It could be. It could be a podcast. It could be a writer. Anything that you could think of that has has really helped shape your journey to to the force that you are today. 

Mara Levy I think something else to really look at is the health at every size movement, which is very relevant to health care providers. And most of the principles I've been talking about today are based on and aligned with those models. So there's Asda, as D.H. is the organization that trademarked the term. But there's a lot of other, you know, there's a book health at every size. There are a lot of things to look at for how do we really think about supporting our clients health at whatever size they happen to be? Because everyone can be healthier by doing things that support health. 

Lindsey Vestal Yep. So well said. Any other last thoughts? I feel like I could talk to you about this for four hours, and I'm trying to make a concerted effort to have shorter podcasts in 2025. I am dying to continue our conversation. It is there. Is there anything else that comes to mind that you'd like to share with us today? 

Mara Levy I think just remember, fat bias is not inherent to humanity. This is new. This is just the last couple of hundred years. 

Lindsey Vestal And in fact, it was not even that it was actually revered. As I recall, your presentation and our trial. Right. 

Mara Levy You also look at Renaissance art. Yeah. There's a reason we call women with larger bodies. Ruben, ask now. But even looking at the most ancient models of goddesses we have. Our bodies that would be stigmatized today. 

Lindsey Vestal So grateful for this conversation today and for all of the refreshing, essential topics that you're bringing to our attention. Keep keep on doing that. We're so appreciative of you. And where where can we find you and where can we learn more? 

Mara Levy I would love to see you. So my website is Rainbow Spring wellness.com and that's where you can go if you want to look at blog posts. I've made resources I've put up or of course see me for appointments in D.C., Maryland, Virginia Online, or Silver Spring, Maryland in person. I am not super active on social media, but I am on Facebook, Instagram. I think I might have put up a profile on Blue Sky, but my name is Rainbow Spring Wellness pretty much everywhere. 

Lindsey Vestal That's fantastic. Can't wait to learn more. Thank you so much for your time today. 

Mara Levy Thank you so much for having me, Lindsey. Absolutely. A pleasure. 

Lindsey Vestal Thanks for listening to another episode of Otis and Pelvic health. If you haven't already, hop on to Facebook and join my group Otis for Pelvic health, where we have thousands of Otis at all stages of their pelvic health career journey. This is such an incredibly supportive community where I go live each and every week. If you love this episode, please take a screenshot of this episode on your phone and posted to IG Facebook or wherever you post your stuff and be sure to tag me and let me know why you like this episode. This will help me to create in the future what you want to hear more of. Thanks again for listening to the Otis and Pelvic health podcast.