Metabolic and bariatric surgery (MBS) provides an effective physical tool that helps patients who suffer from obesity meet their health and weight loss goals. However, while surgery induces anatomical and physiological changes, surgery on its own cannot fulfill optimal results if the patient themselves are not engaged in making necessary lifestyle and behavior changes. Even with the MBS tool, changing lifestyle is not easy. A patient’s lifetime of adverse dietary and exercise habits, beliefs, perceptions, and even cognitive dissonance need to be relearned. Successful patients with MBS are not defined by a number on the scale, but rather taking a holistic stance, and involve motivation, engagement, positive thinking, strategies to overcome challenges, and lifelong support. Practitioners who devote their profession to helping patients with MBS need to understand the stages of change patients may wax, wane, and transition through. The transtheoretical model of change provides the theoretical underpinning to this behavior change. The stages include precontemplation, contemplation, preparation, action, maintenance, and relapse. Understanding what stage the patient presents with can guide our counseling technique and support effective interventions. Counseling a patient that is in the precontemplation stage as though they are in the action phase would be ineffective and frustrating for all. This chapter will describe each stage and give relevant examples of how practitioners can recognize the stage of change the patients present with. More importantly, this chapter will also provide how to motivate and guide patients through each stage to facilitate meeting goals. Offering support groups is also an integral strategy to keep patients informed, engaged, and motivated in their journey.