Table 4.

Recommended approach and MI-based strategies for each stage of change to support patients in implementing behaviour change for weight management

Stage of Change	Description of patient behaviour	Suggested approach	MI support strategies
Precontemplation	Patients in this stage do not recognise the health consequences associated with being overweight or obese and lack intention to change	• Educate on potential health impacts (e.g., increased risk of chronic disease and disability) and associated impact on quality of life • Provide gentle, non-judgemental advice tailored to their personal goals and values	• Express empathy and avoid confrontation • Highlight discrepancies between current behaviours and desired outcomes • Acknowledge autonomy to build trust
Contemplation	Patient is aware of benefits of weight loss and is considering behaviour change. They evaluate benefits like better health against perceived sacrifices. Common thoughts include, “I know I need to eat healthier, but I’m not ready yet”	• Support them to weigh the pros and cons of change • Where possible, refer to dietetics and exercise professionals to prepare programs	• Guide patients through a decisional balance exercise to evaluate both the benefits of their behaviour and the potential gains of change • Listen for "change statements", such as expressions of concern or intent to change, and reflect them back to the client • Assess how long the patient has been contemplating change and explore past attempts to identify barriers • Foster self-efficacy by instilling hope and confidence that change is achievable • Be patient and persistent, as moving from contemplation to preparation often takes time and multiple discussions
Preparation	Patient has decided to take action. Have started to research ideas such as healthy meal ideas or exercise classes that are available locally. May have made small steps towards change, e.g. cutting out one sugary drink per day or signing up to the gym	• Support to develop a realistic plan for action, with small achievable goals to begin with and a main goal. Collaborate on planning to increase patient ownership of the process • Offer a menu of choices (each geared toward positive change outcomes) and incremental options for change	• Offer Options & Support: Present various strategies for change, and discuss available support systems to enhance accountability and success • Identify Barriers & Solutions: Explore potential obstacles and develop strategies to overcome them, ensuring the patient feels prepared for challenges • Strengthen Confidence & Commitment: Reinforce the patient’s strengths, build confidence, and encourage firm commitment to action, while acknowledging any ongoing ambivalence
Action	Patient is consistently implementing behaviour changes to manage weight	• Monitor progress and review plan to ensure behaviour change is still progressing towards main goal • Celebrate successes • Provide strategies to overcome setbacks or barriers (e.g., meal planning, other life events being prioritised)	• Support & Reinforce: Offer ongoing support to help patients stay on track and address any conflicting feelings they may have about the changes • Acknowledge Effort: Recognise the visible changes and affirm the patient’s commitment to their behaviour modification • Build Self-Efficacy: Strengthen the patient’s belief in their ability to maintain the changes by highlighting their successes and reinforcing their autonomy • Celebrate Achievements: Celebrate milestones and reinforce that their efforts are valid and important for long-term success
Maintenance	Patient has maintained behaviour change for six months or more	• Review and revise action plan so that strategies are geared towards maintaining behaviour change and/or the goal health state achieved (e.g. healthy weight, incorporating vegetables into at least one meal a day, performing resistance training two times a week) • If possible, schedule time to monitor and review every 6–12 months	• Sustain Change: Help patients consolidate gains and maintain changes to prevent regression, recognising that this stage can last from months to a lifetime • Prevent regression: Identify potential triggers such as stress and social events and develop management strategies. Acknowledge that it may occur, viewing it as a learning opportunity rather than failure. Guide patients through"regression crises"to rebuild self-efficacy and motivation • Learn from Setbacks: When regression occurs, support the patient in reassessing their plan, learning from the experience, and reinitiating the change process