It isn't even worth it if there are mounds and mounds of fat in the way.  It can become impractical for palpation of some areas when the person has been eating as if they are saving up to hibernate for a few years.  In PT school my classmates were almost entirely lean and fit, and practicing on them vs. being out "in the trenches" during clinicals with real patients is a different experience because almost everyone is obese. Edit: Plus, I tell them to see a massage therapist if they want a massage.  I let them know we will be doing primarily active interventions in PT, haha.... Oh, so easy to trigger...