Ire counseling be given by physicians, nurse practitioners, clinical nurse specialists or physician assistants. More than 30% of people in the medicare population are obese, which increases their risk of type 2 diabetes, heart disease and many types of cancer. viagra generic Some research suggests that physicians can assist patients in weight loss. buy viagra without prescription Thomas wadden, director of the center for weight and eating disorders at the university of pennsylvania's perelman school of medicine, published a study earlier this month that found physicians, with the aid of their medical assistants and meal-replacement plans, helped obese patients lose and keep off 10 pounds over two years. The medical assistants and physicians got weight-loss training before they started counseling patients. He said he hopes insurance companies will follow cms' "bold lead" and pay for obesity treatment. viagra from canada online pharmacy Wadden also said he believes that cms should consider reimbursing a range of weight-loss options, including telephone- and internet-based programs, which have been shown to be effective. viagra daily 36 "such programs could be coordinated with primary care providers efforts and delivered at a far lower cost than having physicians or nurse practitioners deliver lifestyle counseling. buy real viagra canada " several other large clinical trials show that dieters who followed intensive weight-loss programs with trained professionals and a lot of one-on-one counseling lost an average of 9% of their starting weight, ryan said. However, most physicians can't spend huge amounts of face time with their patients, she said. "the physician should probably be part of the assessment team and the primary motivator, but someone else in the office should teach the lifestyle changes that will lead to weight loss. viagra pills "the problem is going to be how to make this efficacious and affordable. It's a question of economics," ryan said. Not everyone agrees that counseling is the best approach. viagra daily 36 Deborah cohen, a physician and senior natural scientist at the rand corp. , a think tank, said that as dieting, counseling and nutritional information have increased, the obesity epidemic has continued to grow. how much does viagra cost on the street "it shouldn't be doctors," she said. "we should have a professional food industry that sees itself as a health care provider," cohen said. order viagra online "instead, we're being encouraged to eat food that makes us sick. viagra men ingredients " policy should focus on changing an environment that encourages eating too much: large portion sizes in restaurants, "fourth meal" at fast-food joints, super-sizes only for food that causes heart conditions and fatty snacks within easy reach at the ends of grocery aisles. "how many people had nutrition counseling before the obesity epidemic hit? canadian online pharmacy no prescription viagra " cohen said. viagra wholesale "it's not. viagra daily 36 Plaza del Carmen, 6
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