Table 1. Objectives, Duration, and Content of the Intervention Framework (Session-wise).

*Microsoft® Corp., Redmond, WA

NAFLD: non-alcoholic fatty liver disease

Session 1: (Face-to-face)
a) Theme: Introduction to fatty liver disease and its management	a) OBJECTIVES: To form a rapport with the patient and accompanying family member, to introduce the disease and its management, and to highlight the goal of 5% - 10% bodyweight reduction in six months.
b) Timing: On the day of enrollment
c) Duration: 60 minutes	b) INTERVENTION: Rapport formation with the patient and family members, introduce the role of lifestyle management in NAFLD, explain the meaning of the deranged metabolic parameter, set small and achievable goals for the patient, and encourage buying of a weighing scale; Customized diet pattern, based on the principles of a balanced diet with a one-day sample diet plan (based on economic, cultural, regional preferences and associated symptoms and comorbidities with NAFLD); Introduce the concept of “Sitting less for a healthy liver” and the benefits of regular walking in NAFLD; Teach to write a food diary; Exchange phone numbers
d) Tools employed: Microsoft ®  Powerpoint* presentation, a sample of a food diary, customized diet chart
Session  2: (Telephonic)
a) Session theme: Reinforcement of prescription	a) OBJECTIVES: To strengthen the rapport and emphasize on the prescribed diet.
b) Timing: within 15 days from the first session;	b) INTERVENTION: Reinforce the prescription, explaining the importance of a balanced yet calorie-controlled diet; Emphasize the concept of small and frequent meals; Motivate to maintain a food diary; Clarify doubts, if any
c) Duration: 10 - 15 minutes
d) The tool employed: Checklist
Session 3 (Telephonic)
a) Session theme: Monitoring of compliance and progress	a) OBJECTIVES: To monitor the progress of the patient in terms of dietary and physical activity changes, as well as weight loss; To motivate the patient to adhere to the prescription. b)
b) Timing: At the completion of one month
c) Duration: 10 - 15 minutes	b) INTERVENTION: Inquire whether the recommended changes have been made in the daily diet and physical activity; Inquire about the weight loss; Explain the progress to the patient and motivate for adherence and further improvement (if required); Clarify doubts, if any
d) The tool employed: Checklist
Session 4 (Face-to-face)
a) Session theme: Weight management and meal planning	a) OBJECTIVES: To empower the patient with the basic knowledge of meal planning for healthy eating; To emphasize the role of exercise in weight loss and improvement of fatty liver disease.
b) Timing: At the completion of two months
c) Duration: 30 - 45 minutes	b) INTERVENTION: Check the food diary to understand the routine of the patient; Session on how to plan your meal and recommended food group intake; Role of exercise in weight management and setting your exercise targets
d) The tool employed: Microsoft® PowerPoint presentation
Session 5 (Face-to-face)
a) Session theme: Progress report and way ahead	a) OBJECTIVES: To reset a new diet and exercise goal for the patient as per their progress in the preceding three months; To explain the journey of weight loss and associated barriers to the patient.
b) Timing of the session: At the completion of three months
c) Duration: 30 minutes	b) INTERVENTION: Check the food diary to understand the routine of the patient; Give a new customized diet plan based on the current need of the patient (weight loss or maintenance); Explain possible reasons to the patient, in cases where no progress is made; Explain the plateau effect and measures to overcome it; Set new weight loss and exercise targets for the patients, if required; Give a recipe booklet on low calorie snack
d) Tools employed: Handouts, recipe booklet, and diet chart
Session 6 (Telephonic)
a) Session theme: Motivation and reminder	a) OBJECTIVES: To motivate the patient to continue with the prescribed lifestyle prescription; To make the patient feel positive.
b) Timing of session: At the completion of three months, 15 days
c) Duration: 10 - 15 minutes	b) INTERVENTION: Reminder call to check progress and keep motivation high.
d) The tool employed: Checklist
Session 7 (Telephonic)
a) Session theme: Compliance check and motivation	a) OBJECTIVES: To motivate the patient to continue with the prescribed lifestyle prescription; To make the patient feel that he is being constantly monitored.
b) Timing: At the completion of four months
c) Duration: 10 - 15 minutes	b) INTERVENTION: Reiterate the role of weight loss in the improvement of liver function; Motivate the patient to maintain a positive mind frame regarding a permanent lifestyle change
d) Tools employed: None
Session 8 (Face-to-face)
a) Session theme: Managing your eating behavior	a) OBJECTIVE: To empower the patient to make informed food choices that are healthy.
b) Timing: At the completion of five months	b) INTERVENTION: Education session on how to read nutrition labels? Show some sample labels and their interpretation; How to eat healthy while eating out; Identifying cravings, reaction to cravings, and how to get back on track; How to control social influences to not disturb your diet; Simple sugar and fat amounts in some snacks and beverages
c) Duration: 30 minutes
d) Tools employed: Food labels, handouts
Session 9 (Face-to-face)
a) Session theme: Final assessment and way ahead with self-management	a) OBJECTIVES: To analyze the progress made by the patient during the 6-month self-management in terms of metabolic parameters To enhance motivation to maintain behavior change by recognizing personal successes so far.
b) Timing: At the completion of six months
c) Duration: 30 minutes	b) INTERVENTION: Final progress assessment of the patient; Helping the patient develop a healthy eating and exercise pattern for the future; Busting some myths about weight loss; How to stay motivated in the long run?
d) The tool employed: Handouts