Despite the best treatment some patients seem unwilling to change because

Because changes recommended usually do not just include one change, but many hard daily decisions.

Many of the lifestyle changes physicians expect patients to make may include pain, financial deliberations associated with healthcare costs, social isolation, a perceived loss of independence, and the trouble of breaking old habits. Patients may also be terrible or ignorant about the process of therapy and their role in it. Interpersonal difficulties can also reduce willingness to treatment. Therapy may represent a strong threat to self-esteem, implying that clients are inadequate.