Almost every decision every society has ever made, in my opinion, has been based on fear. Every group or individual seems to place fear as a primary guiding principle. Unfortunately, fear is a stern master. Those who live in its house are its slaves.

I remember talking to a man who was a heroin addict for many years and had quit. I asked him about it, and he replied, “Heroin [gave me] the greatest feeling I ever had when I was using it, but I knew it would kill me.”

In most of my columns, I have discussed the many ways in which we can change our behavior for the better; however, the ability to change still eludes many of us. Many people who continually claim to want to change keep living their unhealthy lifestyles and reaping the unfortunate results. No matter how debilitating or severe their condition, they will not change the behaviors that cause it. I guess I’m lucky to have stumbled onto a healthy way of living; if I needed to be different, I probably couldn’t do it.

It looks like we are not alone in our inability to change, in spite of seemingly convincing evidence that we need to change for our own good.

A recent international study commissioned by Bupa Health Pulse confirmed that people will continue to smoke, drink and avoid exercise despite knowing that their unhealthy lifestyles will lead to long-term chronic diseases.

Researchers surveyed 12,000 people from 12 countries (Australia, Brazil, Britain, China, France, Germany, India, Italy, Mexico, Russia, Spain and the United States). Almost half admitted that they only exercised an hour or less a week; 70 percent claimed to drink alcohol and almost a third said they smoked.

Topping this unhealthy list were the British, who had the highest proportion of drinkers at 84 percent; Russia had the greatest percentage of smokers at 43 percent.

Even with these unhealthy lifestyles, however, the survey found that 80 percent of the respondents said they were worried about developing chronic diseases from these behaviors.

“While we seem to be aware of the prevalence of chronic disease in society, we’re not doing enough to reduce our risks of developing a long-term condition,” said Sneh Khemka, the medical director of Bupa International, in a prepared statement.

When asked about their concerns of developing chronic diseases, a third of respondents were most worried about cancer. Only 11 percent were most worried about heart disease, while only 8 percent were concerned about diabetes. These values are significantly lower than the likelihood of individuals actually developing these diseases.

When asked to give their reasons for not making healthier lifestyle choices, 24 percent of those surveyed said lack of time. Almost 20 percent said they lacked motivation, while 14 percent said changes would be too expensive.

“We know from research that exercise is one of the most effective lifestyle changes you can make to reduce your risk of developing long-term conditions,” said Julien Forder, a senior research fellow at the London School of Economics, who worked with Bupa on the report. “Nearly a third of cardiovascular disease and more than a quarter of diabetes could be avoided if everyone started to exercise.”

Pathological defensive mechanisms

When I studied psychiatry, I learned about the defense mechanisms we all use to cope with reality and maintain an intact self-image. However, a defense mechanism becomes pathological when it is used persistently and leads to behavior that will eventually threaten the physical and/or mental health of the individual.

Examples of these maladaptive pathological behaviors include denial, or a refusal to accept external reality because it is too threatening; distortion, or a gross reshaping of external reality to meet internal needs; and delusional projection, which describes actual delusions about external reality.

Be very afraid

When we use defense mechanisms such as these, we will not avoid the consequences of our behavior. If fear is the motivator, and you are not facing the truth, be very afraid of what will certainly happen to you. If you read these columns, you know what changes you must make in spite of your defenses.

A few years ago, I wrote about the lessons I’ve learned from my horse. After riding the other day, he taught me another one: If I keep leading my horse to water, sometimes he is thirsty.

Are you thirsty?

Ed. note: Dr. J’s posts now also appear on the CalorieLab Facebook Page.