Why are unhealthy people so reluctant to change their lifestyles?


Nobody’s perfect. We all have bad habits we just can’t seem to shake. Cigarettes have a hold on some people; others can’t say no to alcohol, sweets or a life on the couch in front of the television.

As much as we may want to make more healthful choices, change is difficult. Even the awareness that our behaviors can harm us often isn’t enough to make us mend our ways.

Amazingly, people who have already suffered heart trouble, diabetes or other lifestyle-related illnesses —people who intimately know the consequences of their behaviors — often have an especially hard time turning things around. It seems it takes more than a wake-up call, even a life-threatening one, to get people to give up their unhealthful ways.


At least 40% of smokers who survive a heart attack are still puffing away a year later.

And you might think that an overweight person would slim down after a heart attack. But often, not so. Researchers at Washington University in St. Louis followed a group of more than 1,200 overweight men and women for a year following a heart attack. Their study, published in the American Heart Journal in 2007, found that individuals lost an average of just 0.2% of their body weight. For a 220-pound man, that would translate to less than 1 pound of weight loss.

If a heart attack isn’t enough to get a person’s attention, what about cancer? You can probably guess by now. In a 2008 study in the Journal of Clinical Oncology, Canadian investigators examined the lifestyles of more than 9,000 cancer survivors and found that only a few had made the switch to a healthful lifestyle. Although most had given up smoking, fewer than 20% were consuming five servings of fruits and vegetables a day and less than half were engaging in regular physical activity. Only 1 out of every 20 survivors was following all three principles of healthful living.

After a serious illness, lifestyle changes often have the potential to dramatically improve a person’s overall health and quality of life. In fact, lifestyle factors such as smoking, diet and physical activity strongly influence how rapidly many diseases will progress.

Researchers at Brigham and Women’s Hospital in Boston examined the effect of smoking cessation on the risk of dying after a heart attack. Their work, published last year in the Journal of the American College of Cardiology, found that smoking significantly decreases life expectancy after a heart attack and that smokers’ prospects improve dramatically if they give up the habit. Individuals who quit after their first heart attack were 37% less likely to die of another attack compared with those who continued to smoke.

Other studies have found that heart attack patients who go through exercise-based rehabilitation reduce their risk of dying by about 30%.

The power of lifestyle changes isn’t unique to heart trouble. Quitting smoking improves the outcome of diseases such as diabetes and emphysema, while weight loss improves asthma, sleep apnea and many other conditions. The benefits of physical activity extend well beyond the heart too. Exercise can be helpful in combating depression and controlling high blood pressure. There’s also some evidence that it has a protective effect against some types of cancer. Several studies have demonstrated that women with breast cancer who participate in regular physical activity reduce their risk of breast cancer deaths by 50% or more compared with those who remain physically inactive.


But not all patients get this message, partly because doctors often fail to provide sufficient counseling and guidance. Researchers at the Centers for Disease Control and Prevention asked more than 1,600 cancer survivors if their physicians had discussed lifestyle issues with them following their diagnosis. Only 30% had received guidance about diet, just 1 in 4 had been given exercise recommendations and less than half had been asked about their smoking habits.

Even patients who know they should adopt more healthful habits and are determined to do so have trouble, however. “A lot of people don’t change because they don’t know how to change,” says Janice Prochaska, president of Pro-Change Behavior Systems, a behavior change firm. Getting people to alter their habits is extraordinarily difficult, and, for most people, it isn’t something that happens overnight, she says.

Change is hard, but it’s not impossible. People first have to recognize that the benefits of changing their lifestyle will outweigh the investment of time and energy (not to mention the hassle) it’s going to take to make it happen.

After that, there’s a period of preparation most people go through. Rather than jumping straight into action, they begin by making small adjustments in their lifestyle. Someone committed to increase his or her activity level, for example, may go for a few short walks; someone attempting to lose weight might start to scale back on desserts.

Only then are people typically ready to take action and make a full-fledged attempt to change. And that’s still just the beginning. Change needs to be maintained. After all, it doesn’t make sense to quit smoking only to light up again months later or lose weight just to gain it all back.

Even a serious health scare may not be enough. “You may get a wake-up call and get pushed into action by your family,” says Prochaska. “But you may not be sufficiently well prepared to stay in action.”


Trying to rush through the steps of change too quickly can be a setup for failure. “Some people who jump too quickly into action regress and then feel demoralized,” Prochaska says.

It’s hard to think of illness as an opportunity but, in fact, for many people it is. It’s an opportunity to stop pretending that our bad habits don’t hurt us and to take the initiative to make healthful change.

Or at least it should be.

Ulene is a board-certified specialist in preventive medicine in Los Angeles. The M.D. appears once a month.