Motivational to Weight Loss Version 1 (MWL v.1): Protocol for a Feasibility Single-arm, Open-label Clinical Trial of a Motivational Interviewing, Stages and Processes of Change-based Intervention for Weight Loss in Adults

The study will consist of one session per week for 8 weeks, during which the participant will receive MI for 30-45 minutes. All participants will receive the MI intervention according to their readiness to lose weight measured by means the P-weight and S-weight at the beginning of each session.

In session one, sociodemographic and clinical information will be collected through a structured interview as well clinical assessment including the following scales: the stage of change to lose weight (S-Weight), symptoms of depression (PROMIS depression v. 8.1a, ), anxiety (PROMIS anxiety v.8.1a, ), psychosocial functioning (FAST ), binge eating (TCAP ), current food intake (24-hours food recall, ), and cognitive process used while losing weight (P-Weight ). In addition, the first session will collect information regarding the participant's body weight, body fat, free fat mass, and waist and hip circumference.

As participants will be in the precontemplation or contemplation stage of change at the beginning of the study, the goals of the first session will be: a) develop participant rapport; b) develop the discrepancy, that is, understand the distance between what the participant wants to change and the actions are taken; c) roll with resistance, that is, do not conflict during the dialogue; d) avoid the correction reflex, that is, avoid correcting something the interviewee says, even if it is technically incorrect or not plausible; e) valuing and validating the person, that is, emphasizing points in the participant's speech to increase their self-confidence; f) establish an agenda of issues to be deal with that are related to being overweight or obese. All these objectives remain in subsequent sessions. To accomplish those goals, the interviewer will use the MI process called "explore," which leads to the topic the participant wants to discuss. The interviewer will use strategies such as open questions, affirmations, reflections, abstracts, exploring discrepancies, informing with permission, explore values and objectives based on the participants' speech in order to elicit from the person their different motives for the desired change . Each session will be registered following the Session Registration Form .

From sessions two to seven, the sessions will take place online through the platform Teams, and the participant will answer the S-weight scale to identify the actual stage of change to lose weight at the beginning of each session. In case of the participant is in the precontemplation, contemplation or preparation phases, the goals in the session will be a) encourage the participant to talk about the reasons that favor him to change and not to change; b) focus on the positive motives to change; c) Increase the participants' confidence, that is, explain that the style of this approach takes into account their autonomy, and thus, any and all decision-making will be shared and not directed from the interviewer to he/she, also because a basic premise of MI is that people are experts on themselves; d) extract from the participant how he/she could make the change, anticipating what it would be like if he/she had already made the change; e) show options for the participant to choose from, based on their own answers; f) stimulate through questions and reflections that the participant himself talks about his/her abilities, this increases the confidence that he is capable of doing things; g) prepare the participant for the action phase; h) predict difficulties; and i) prevent relapse. However, if the participant is in the action, maintenance, or relapse phase, the goals will be to a) stimulate the participant to develop solutions to promote autonomy and confidence in the decision-making process; b) reinforce the commitment to change; c) recall the participants' values through reflections; d) validate the actions already taken, even if they are damage reductions; e) support self-confidence; f) increase support network; g) prevent relapse; and h) consolidate the gains from the changes made.

The goals established in sessions two to seven will be pursued by the interviewer by using the MI process "focus," "evoke," and "plan". Focus will direct the conversation toward the possibility of change, creating a discrepancy between the participants' current actions and their broader life goals and values . Evoking will stimulate the participant to talk about their motivations for change. Planning includes helping the participant to identify a goal, building an action plan, and anticipating difficulties. The interviewer will use strategies such as closed questions, open questions, reflection, importance rule, and trust ruler.