National Health Service Essay

The purpose of this essay is to highlight the issues and key factors on how obese individuals are treated and whether obese people should be treated in the same manner as cancer patients. Obesity which is a condition of health that results in people having a body mass index that is greater than 30; is defined by Black Media Dictionary as a medical condition in which excess body fat has accumulated to the degree that may cause an adverse effect on health. However Hannah Sutter in her book argued that it is possible to have a body mass index (BMI) greater than 30 without being obese.

From my research I have found that obesity can lead to various terminal diseases such as diabetes, high cholesterol, high blood pressure and even cancer itself. Cancer is understood as the mutation of cells which gets out of control and begins multiplying vigorously; Mary Lunnen (author of Cervical Cancer – The Essential Guide) defines cancer to be malignant tumours in which the cells tend to spread to other parts of the body via the blood or the lymph glands, resulting in it becoming cancerous. However Dr Harvey Marcovitch (2010) suggested that not every tumour is cancerous. It is however agreed by all literatures reviewed that both obesity and cancer can be terminal diseases.

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Figure 1 – External Image of the Bowel

Cancer is the general term used to refer to malignant tumour, it is caused when normal replacement process of cells, get out of control and produce a tumour. Within cancer there is a primary site and a secondary cancer (which can be called metastasis). Primary cancer are different types of cancer which are identified as lung cancer, bone cancer, breast cancer etc. Whereas secondary cancer (or metastasis) is the result of the cancerous cells spreading, leading other tumours to develop at different places in the body. Nonetheless it is not curable however there are treatments offered to slow down the spread of the cancerous cell and control the pain – shrinking the tumours that are pressing on the nerves. In particular bowel cancer (also known as colorectal cancer or colon cancer), which is a cancerous condition that affects the colon (large bowel) and rectum (back passage); usually grows very slowly over a period of ten years, before it starts to spread and affect the rest of the body. Beating Bowel Cancer (2010) reported that most bowel cancers start as benign innocent growth – called polyps – on the wall of the bowel. Polyps are common as we get older and most polyps are not pre-cancerous. One type of polyps called an adenoma can however become cancerous (malignant) if left undetected.

Ian Eustace (2011) stated that bowel cancer is the third most common cancer in the UK (both male and female), resulting in each year 37,000 people being diagnosed with bowel cancer – 20,400 men and 17,000 women, altogether 80% of bowel cancer patient are 60 years old and above. An individual with bowel cancer can undergo various procedures such as Colonoscopy; a colonoscopy is a procedure in which a long, thin, flexible telescope (a colonoscope) is passed through the patient’s anus into their rectum to be looked at in detail. Another common procedure used on bowel cancer patient is CT Colonography; a test that uses X-Rays to build up a series of images of the patient’s colon and rectum. The computer then organises the images to create a detail picture that may show polyps or anything else unusual on the surface of your colon or rectum. Surgery is what follows after the procedures in which Ian Eustace (2011) noted that surgery can result in 80% of the bowel being removed; Surgeon remove the tumour and an area of healthy tissues surrounding the tumour (margin) to ensure that all cancer cells have been removed, this is followed up by regular check-ups with the doctor. Nonetheless the number of procedures carried out each year on a bowel patient, along with the number of surgeries performed each year on bowel cancer patients, is leading to cost the NHS (National Health Service) greatly. Figure 2 – The Rates of Bowel Cancer

Paul Trueman (2009) reported that bowel cancer patients cost the NHS approximately £1.1 billon pounds a year. These figures takes into account the cost of diagnosis, treatment and palliative care – meaning the annual cost of treating a patient with bowel cancer is around £8,800; but how many people survive the treatment? It has been found (Cancer Research UK, 2012) that bowel cancer is the second most common cause of cancer death in the UK after lung cancer. Around 16,000 people died of bowel cancer in 2010 in the UK – 44 people every day. Worldwide bowel cancer killed more than 600,000 people in 2008, more than half of these deaths are in the more developed regions of the world.

Before bowel cancer becomes terminal there are many symptoms that arises. Initial symptoms of bowel cancer stated by NHS (2012):

1. Blood in their stools (faeces) or bleeding from their rectum

2. A change to their normal bowel habits that persists for more than six weeks, such as diarrhoea, constipation or passing stools more frequently than normal

3. Abdominal pain

4. Unexplained weight loss

However as the bower cancer progress, so do the symptoms; leading to constant bleeding in their bowel. Eventually their body would not have enough red blood cells resulting in them becoming anaemic. Symptoms of anaemia include:

1. Fatigue

2. Breathlessness

In some cases, bowel cancer can cause an obstruction in the bowel. Symptoms such as:

1. Feeling bloated (this is usually around the belly button)

2. Abdominal pain

3. Constipation

4. Vomiting

Once these symptoms have been found the individual can or will undergo different procedures to confirm the diagnosis, such as bowel cancer screening test (also know as colorectal cancer screening test). As stated by (ACS, 2011) a screening test consist of several different tests. These tests are divided into two broad groups:

1. Tests that can find both colorectal polyps and cancer. These test look at the structure of the colon to find any abnormal areas. This can be done either by a scope inserted into the rectum or with a special imaging (x-ray) tests.

2. Tests that are mainly find cancer. These tests check the stool (faeces) for signs that cancer may be present.

Another procedure that can be used to confirm the symptoms is FOBT (Fecal Occult Blood Test). Noted by ACS (2011) the FOBT is used to occult blood (blood that is not visible with the naked eye) in faeces. The idea behind the test is that blood vessels at the surface of the bowel cancer are often fragile and easily damaged by the passage of faeces. The damaged vessels usually release a small amount of blood into the faeces, but only rarely is there enough bleeding for blood to be visible in the stool. Therefore the FOBT detects the blood in the stool through a chemical reaction. However the test cannot predict whether the blood is from the colon or from other parts of the digestive system (such as the stomach). Although is the test is positive, a colonoscopy is used to determine the cause of the bleeding. The screening test is a kit that can be done in the privacy of your own home; allowing you to check more than one stool sample.

There are many different factors that can cause bowel cancer and its symptoms, the list can be endless. Research shown by (Ian Eustace, 2011) not only shows the many type of cause but the link between cancer and obesity. According to Eustace (2011) people with diabetes are more likely to develop bowel cancer. People with type 2 diabetes have an increased risk of developing bowel cancer. Both type 2 diabetes and bowel cancer share some of the same risk factors (such as excess weight); eating large amounts of red and processed meat appears to increase the risk of bowel cancer.

This is due to red meat containing a chemical called haem (gives the meat its read colour) that might increase the risk. Furthermore cooking meat at high temperatures (frying or roasting) is thought to result in the production of chemicals that cause bowel cancer. Moreover low physical activity and obesity can be associated with the increase of bowel cancer. Apart from the causes that link bowel cancer and obesity together, there are other causes such as smoking; long-term smokers are more likely than non-smokers to develop and die from bowel – some of the cancer-causing substances in smoke can dissolve into saliva and if swallowed can cause digestive system cancer like bowel cancer. Heavy alcohol use; bowel cancer has been linked to heavy alcohol use because users tend to have low folic acid in the body. All theses are lifestyle related factors that can be changed.

On the other hand there are many factors that cannot be changed. As mentioned above age, it is possible for younger adults to develop bowel cancer but the chances increase greatly after the age 50. NHS (2012) noted that ‘more than 9 out of the 10 people diagnosed with bowel cancer are older than 50. Another unchangeable factor is the disease developing through genetic inheriting. American Cancer Society (ACS, 2011) reported that about 5 – 10% of people who have developed bowel cancer have inherited the gene mutations that cause the disease. Often these defects lead to cancer that occurs at a younger age than is common. Therefore identifying families with these inherited syndromes is very important as it allows doctors recommend specific steps, such as screening and other preventive measures. (ACS, 2011) also reported that Peutz-Jeghers syndrome and MUTYH-associated polyposis are two inherited genes that can cause bowel cancer. Peutz-jeghers, which is a rare condition, tends to result with the individual having freckles around the mouth (and sometimes on hands and feet) and a special type of polyp in their digestive tracts (called hamartomas).

This syndrome is caused by mutations in the gene STK1. MUTYH-associated polyposis, is a syndrome in which colon polyps develops and becomes cancerous if the colon is not removed. This gene is caused by mutations in the gene MUTYH. Lastly an unchangeable factor that causes bowel cancer is an individual’s racial and ethnical background. According to ACS (2011) African Americans have the highest bowel cancer incidence and mortality rates of all racial groups in the United States. Jews of Eastern European descent (Ashkenazi Jews) have one of the highest bowel cancer risks of any ethnic group in the world. Studies have shown that there are several gene mutations leading to an increased risk of bowel cancer found in this group. The most common of these DNA changes, called the 1307K APC mutation is present in about 6% of American Jews.

Additionally there are also factors that can be labelled as the cause, however brings up uncertain, controversial, or unproven effects on bowel cancer. ACS (2011) claims that results of studies suggest that working a night shift at least three nights a month for at least fifteen years may increase bowel cancer in women. The study literatures suggest that this may be due to the changes in levels of melatonin (a hormone in the body that responds to the changes in light) in the body. However there is not enough evidence to prove it. Another controversial factor that may cause bowel cancer is previous treatments for certain cancers. Several medical studies have suggested that men who have radiation therapy to treat prostate cancer may have a higher bowel cancer because the rectum receives some radiation during the treatment. Yet most of these studies are based on men treated during 1980s and 1990s

Obesity on the other hand may not sound as equally dangerous; however it has potential to be. Encyclopedia section of Medindia (2012) explains in brief about the symptoms of obesity. The following are the most common symptoms that indicate a person is obese:

1. Large body frame

2. Difficulty in doing daily activities

3. Lethargy

4. Breathlessness

5. Disproportionate facial features

6. Breast region adiposity; this is the sagging fat cells that appear in boys’ breast

7. Big belly (abdomen), sometimes marked with white or purple blemishes

8. Male external genitalia may appear disproportionately small

9. Early arrival of puberty

10. Flabby fat in the upper arms and thighs

11. Knock-knees is common

From my research scientific studies show not only is there a massive link between obesity and being overweight, but the proportion of men and women, who are being classified as obese, have risen steeply in recent years. Dr Michael and Mary Dan Eades (2012) noted that from 1995 – 2005 the proportion of men classed as obese increased from 13.2% – 25.1%; a rate growth of 75% in twelve years. In comparison to women, the proportion of women classed as obese increased from 16% – 24.87%; a rate growth of 55% in the just twelve years. At the same time obesity and being overweight in children has risen, World Health Organisation (WHO, 2012) reported in 2010 globally around 43 million children under five years old were overweight. After considering a high-income country problem, overweight and obesity has increased in low and middle-income countries, particularly in urban setting. Nonetheless they believe close to 35 million overweight children are living in developing countries and 8 million in developed countries. Overall there has been an average increase in obesity of 65%, over the past 12 to 13 years.

(WHO, 2012) defines obesity and overweight parallel to Black Media Dictionary; with overweight being a BMI greater than 25 and obesity being a BMI greater than 30. Obesity can increase the likelihood of various diseases such as heart disease, type 2 diabetes; at its worse can lead to amputation, blindness, heart attack and death. Obesity could even lead to certain forms of cancer (malignant neoplasm). According to the HSE (Health Survey of England, 2011) data by 2012 a staggering one in three people will be obese in the UK. Currently based on the WHO (2012) data globally there is more than one billion overweight individuals. As you are aware, our current economy state is in a recession therefore the government is lead to make spending cuts; reported by Channel 4 News (2011) more than 50,00 NHS jobs will be lost over the next five years. Last year the Prime Minister (David Cameron, 2011) delivered a speech that outlined the Government’s continued commitment to the reform of the NHS, emphasising out some of the reason he believed justified the reforms. High and growing levels of obesity in the UK, associated health costs, was one of the reasons he highlighted. With the NHS facing growing costs from treating patients with obesity linked conditions, David Cameron (2011) quoted ‘Take obesity; it already costs our NHS a staggering £4 billion a year. But within four years, that figure is expected to rise to £6.3 billion.’

The increase in obesity highlights the causes; Cancer Research UK (2009) stated that the cause of obesity is simply the result of taking in more calories through your diet that you are burning through physical activity. The reason for this calorie imbalance vary from person to person, it can be caused by a combination of environment, genes and behaviour. The environment can contribute to the causes of obesity through lifestyle – food tastes better, it is available in more varieties, and is cheaper, especially processed food. For convenience more people are eating pre-packaged food, fast food and fizzy drinks, which often all of these are high in calories, fat, salt and sugar. We are also living more inactive lifestyles. The use of cars and public transport over walking or cycling is increasing. Many jobs now involve sitting at a desk for several hours, at the same time inactive pastimes such as watching television and social networking has become more popular. However with obesity developing through genes, regardless of the environment they become obese. Obesity-related genes could affect the way a person metabolise food or store fats. It also affects their behaviour, making the person inclined towards the lifestyle choices that increase their risk of being obese:

1. Genes that control the person appetite; having no sense of when you’re full.

2. Genes that make you responsive to the taste, smell or sight of food.

3. Genes that affect the person sense of taste; giving preferences for high fat foods and hating healthy food.

4. Genes preventing the person from engaging physical activities.

Moreover people with obesity-related genes are not destined to be obese, but will have the higher risk of being obese. In our modern society they would need to work harder to maintain their health. Finally behaviour can contribute to the causes of obesity; an individual with no self-discipline is likely to end up obese than an individual with self-discipline. Self-discipline is being able to not submit to food but take control – how much your going to eat, when you are going, not eating in a way that corresponds to your emotions. Being obese can lead to many serious medical problems, such as high levels of leptin; a hormone produced by fat cells in the body, which could be used to explain the dangerous blood clots that develop in obese people, causing them to have heart attacks and stroke – more often than people who are not obese.

Similar to bowel cancer there are many treatments for obesity. The aim of these treatments is to obviously lose weight and improve the general quality of the person life both physically and psychologically. The best way to treat obesity is to reduce the amount of intake of calorie in their diet and to exercise more. The type of diet and exercise needed to become healthy varies from person to person. According to NHS Choices (2010) a healthy diet is one of the most common treatments offered to an obese patient. A healthy diet should contain:

1. Meals based on starchy, high-fibre carbohydrates such as wholegrain bread, pasta and rice.

2. Five portions of fruit and vegetables every day.

3. A moderate amount of low-fat protein, milk and diary products.

4. A very small amount of foods that are high in fat, sugar or salt

Another type of treatment that can be offered by their GP (General Practitioner) is calorie-controlled diet. Calorie-controlled diet defined by (NHS Choice, 2010) is a diet based on how much the person is currently eating, and then attempting to cut the amount of calories they eat each day by around 600. Furthermore increasing their exercise is a effective treatment that can be used by an obese person. Research suggests that increasing the amount of exercise you do, is an effective way to lose weight, and the results are greater when combined with changes to your diet. The advice a GP may give regarding the treatment of exercise varies depending on how fit the patient is from the beginning. There are many types of effective exercise techniques that an obese patient could use such as, aerobic activities. Aerobic activities defined by NHS Choices (2010) are kind of rhythmic, moderate intensity exercises that use large muscles in your legs and bum. The exercise would raise their heart rate, making them breathe harder.

Apart from the physical treatment obese can undergo to lose weight there is also a medication that reinforces their loss of weight. However before an obese patient is offered the medication the GP must see proof of the patient being able to lose weight on a calorie controlled diet. Medication is normally a one part of the weight loss programme, and it requires a lot of long-term changes in life for lasting results. Till date the only medication currently prescribed for obese patient is orlistat. Orlistat operates by blocking the actions of an enzyme (the protein that speeds-up and controls chemical reactions in the body) that is used to digest fat. The orlistat works by taking one capsule with each main meal (a maximum of three capsules a day) – it can be taken either before, during or up to one hour after the meal.

Many people could agree with equality between a cancer patient and an obese patient, as obesity is recognised as a medical condition by the NHS. Additionally (Hannah Sutter, 20212) found that there are some experts in the UK that argue that there is insulin (hormone) that makes the body collect fat. Moreover if you eat lots of food that requires insulin, it is possible the body may over produce insulin and that can lead to insulin resistance and eventually diabetes, therefore it could reasonable to say that obesity is unpreventable and is a medical condition. Drew Payne (2008) quoted ‘Telling obese patients it’s up to them to change their lifestyles will not work. If the NHS does not help, charlatans peddling harmful diets will step in.’ this quote once again enhances the idea that obesity is self-indulgence but a condition that needs to be tackled with professional help – doctors.

However Amanda Platell argued strongly ‘obesity isn’t an illness but a self-induced condition. Why, then should the NHS pay for gastric bands, stomach stapling or expensive medication?’ There are various causes that could agree with Platell as mentioned before, self-discipline knowing how to take control of your body and its thought process. Moreover it could be wise to say if the stopping the NHS from offering treatment could force self-discipline onto obese patient, shocking them into taking responsibility of their own condition, instead of seeking a miracle cure. On the other hand it could be argued that deny medical treatment for obese patient is the same as refusing to treat an alcoholic who needs liver surgery or a smoker who has developed lung cancer, for these are all condition which we can say are of the result of individuals choosing an unhealthy lifestyle similar to an obese person. Yet the crucial difference is that you cannot cure cancer by stopping smoking, nor replace a liver by coming teetotal, whereas obesity vast majority of patients could ‘cure’ themselves simply by following a healthier lifestyle. Still many literature such as World Health Organisation (WHO, 2012) agree with the equality if cancer patients and obese patients.

WHO (2012) claim the fundamental cause of obesity is a medical condition of energy imbalance between calories consumed and calories expended. Also globally there has been an increase in the intake of energy-dense foods which are high in fats, salt and sugars but low in vitamins, minerals and other micronutrients; and a decrease in physical activities due to the increasingly sedentary nature of many forms of work, changing modes of transportation and increasing urbanization. Moreover (WHO, 2012) blame the changes in dietary and physical activities on the result of environmental and societal changes associated with development and lack of supportive policies in sectors such as health, agriculture, transport, urban planning, environment, food processing, distribution, marketing and education.

Furthermore the effects of obesity on society could disagree with the equality of bowel cancer patients and obese patients. Obesity causes health issues and these health issues can roll over easily into work. It can be easily argued that people that work with obese people are put into a tough position, because obese people are more likely to have to call off work due to serious health issues that can occur because of it. Health issues that causes them to miss work, resulting in their colleague having to do excess work, along with their own. Another effect of obesity on society is healthcare, when it comes to paramedics, obese people can place them in difficult situation; being unable to carry the patient into the ambulance in order to get them to emergency care, trying to avoid an inevitable heart attack. According to Dawn Hawkins (2010) paramedics are known to get back injuries trying to help those who are obese get the healthcare they need. Additionally being obese could affect your family. People who are obese tend to be at a much higher risk for early death.

This means their family will be left to pick up the pieces when the patient has passed. It could also put a strain everyday on the patient family, having to take care of things that the patient can’t because they are obese. Moreover it could be argued that obese patient try to avoid the fact that their weight does not just affect them but society. And ignoring the effects on society in general can give them an excuse to stay obese and not have to work at getting into a physical health. On the other hand the effects of bowel cancer on the society could agree with the equality of obesity and bowel cancer. A patient with bowel cancer stated by Scottish Intercollegiate Guidelines Network (SIGN, 2011) undergoes psychological distress which usually remains undetected.

Diagnosis it is difficult for doctors because the symptoms of depression, anxiety, effects of treatment and the cancer itself overlap. Core features of depression include: persisting negative thoughts about themselves and their future, inability to take pleasure from day to day activities and a wish to self-harm. All these factors can easily affect the patient family. For it is difficult for family members to see relative breaking-down in front of them, and having no way of helping them. Just like obesity and its effects on society; having to put their family through the devastation of losing a loved one, having to come up with the expenses to ensure of a befitting funeral for the patient. Moreover it could be argued that bowel cancer patient need to take responsibility of themselves and their actions in particular. Not smoking decreasing their risk of ever achieving bowel cancer. No heavy alcohol use, as reported by NHS (2012) men should have a maximum of two glasses of alcohol and day and women should have a maximum of one glass of alcohol a day.

From my research, combining all the facts and figures, I have concluded in agreeing with the equality between a cancer patient and an obese patient because I found that both sides (bowel cancer and obesity) cancel each other out. This is because I believe there is a vast majority of obese patient that do not intentionally become obese. Moreover I found that (Hannah Sutter, 2012) the government have a large part to play in the large percentage of the population being obese. As the government I believe they should be able to create a type of permit that ensure that food industry make and sell the majority of their food free of artificial ingredients, and guaranteeing the food is fundamentally healthy – it is rich in vitamins and other nutrients needed for a healthy lifestyle. I believe if the cut down of well known fast food restaurants (McDonald, KFC, Burger King) that advertises junk food such as fatty fries and greasy burgers, the demand for fast food will go down, resulting in a decrease in obesity. Additionally from my studies obesity is not only due to excess eating but can be due to psychological reasons. The psychological factors can influence eating habits.

Many people eat in response to negative emotions such as boredom, sadness, anger. People who have difficulty with weight management may be facing emotional and psychological issues. According to WebMD (2005) about 30% of people who seek treatment for serious weight problems have difficulties with binge eating. During a binge-eating episode, people eat large amounts of food while feeling they can’t control how much they are eating. An emotional and psychological factor in child obesity could be due to the child is being neglected by their parents, undergoing series of bullying or even trying to cope through their parents divorcing. In adult obesity it could be a bad break-up, a loss of a family friend or relative, stress from work etc. These are all factors that I believe highlights obesity to not be all self-indulgence. Furthermore from my research which goes as far as the 1980s and 90s experts have found that insulin (as mentioned earlier) along with IGF (insulin-like growth factors) also plays a part in the lives of obese patients.

While insulin levels may fluctuate, IGF changes more slowly. Moreover constant highs and lows in insulin levels can lead to cause an increased level of IGF, which unlike insulin effectively stays at a high level. Also I am aware that it is reasonably to claim that obese patients are costing the government greatly for no reason, when they could easily exercise; yet when you exercise your muscle tissues – which is working hard – will draw on fat supplies to provide energy, nonetheless the person would gain weight than they already have before losing the weight. Overall I believe the stereotypes of obese patients are what causes people to become narrow minded and view obesity as a selfish act on NHS rather than a medical condition which can become terminal.

References

Drew Payne (2008) ‘The NHS should help obese people change their lifestyles to lose weight – blaming patient is dangerous’ available at ‘www.nursingtimes.net’

Daily Mail (2009) ‘Obesity isn’t an illness. It’s self-induced condition. Why then, should the NHS pay for gastric bands, stomach-stapling, or expensive medication’ available at ‘www.dailymail.co.uk’

http://www.nursingtimes.net/the-nhs-should-help-obese-people-change-their-lifestyles-to-lose-weight-blaming-patients-is-dangerous/1943879.article

http://www.dailymail.co.uk/debate/article-1156678/AMANDA-PLATELL-Sorry-NHS-treat-people-fat.html

http://www.nhs.uk/Conditions/Cancer-of-the-colon-rectum-or-bowel/Pages/Symptoms.aspx

http://www.nhs.uk/Conditions/Obesity/Pages/Treatment.aspx

http://www.cancer.org/Cancer/ColonandRectumCancer/DetailedGuide/colorectal-cancer-detection

http://www.patient.co.uk/health/Cancer-of-the-Bowel.htm

http://www.helium.com/items/1781966-effects-of-obesity-on-society

Bowel Cancer – The essential guide by Ian Eustace 2011

http://www.beatingbowelcancer.org/what-bowel-cancer

http://www.york.ac.uk/news-and-events/news/2007/bowel-cancer/

Black Medical Dictonary

http://www.who.int/mediacentre/factsheets/fs311/en/

Cervical Cancer – The essential guide by Mary Lunnen

http://www.channel4.com/news/50-000-nhs-job-cuts-hit-mental-health-services

http://www.gponline.com/News/article/934442/Cost-obesity-NHS-England-rise-62-billion/

NCRI session – The cost of cancer care

Website to use

http://www.netdoctor.co.uk/health_advice/facts/obesity.htm