Stage	Behavior	Physician's goal for visit (to move patient forward)	Tips
Precontemplation	Not considering change	Move toward thinking about change	Get patient talking: “Have you ever considered this before?” “What would have to happen to get you to consider this?”
			Emphasize patient's autonomy: “I'm concerned about your health … of course, this is entirely your decision … I can help when you are ready to change…”
Contemplation	Considering change	Move toward preparing for change	“How have your friends or family members made this change?” “Would you like a list of local programs?” “I have some new information comparing various approaches to weight loss.”
Preparation	Preparing for change (e.g., reading about diets, asking friends about gyms)	Move toward taking action	Praise preparation, discuss options, assist in setting initial goals and behavior targets, and set a start date.
Action	Establishing the change	Maintain change	Praise all efforts, limit suggestions of additional changes to one or two, and begin to anticipate obstacles.
Maintenance	Struggling to maintain the gains	Maintain change	Praise all efforts, limit suggestions of additional changes to one or two, and help patient deal with obstacles.
Identification	Incorporating the change into routine and view of self (the new pattern is now automatic, there is little temptation to lapse)	Maintain change	Praise all efforts.