Dear DOCTOR Owen:

My husband has high blood pressure and high cholesterol. He ignores the doctor’s warnings about the risk and refuses to take medication, to diet, or to exercise. I can’t believe that he chooses to act like an ostrich and bury his head in the sand. Is there any way to motivate him?

Pecking Hen

Dear “PH”:

Ask any doctor how many of his or her patients fit this description and you could fill several legal pads. Denial, as it is called, is a great soother. Denial calms the moment at the expense of the future. Most of us think that denial is a simple matter. But, it may be one of the most intriguing, and dangerous, of the human behaviors. Did you ever hear of The Holocaust, Global Warming, Ecosystems, Big Brother? Well, those are all real events that have impacted, and are presently impacting, all of us. If asked this question, though, a majority of the general population could care less or denies the existence of these events. Why?

A fascinating article appeared in Obesity Research, Vol. 8, No. 3, 241–248, which looked at parental perceptions of obesity-related health risk in their children. The authors reported on a study that focused on African American families, but the insights apply to everyone. The study found that—in spite of a 57% prevalence of obesity in a pre-screened group of children studied— only 44% of their parents perceived a potential health problem(s) and would consider some type of intervention. Even more impressive: A vast majority of parents of these obese children refused to consent to even discuss participating in a survey. Of 1,700 children identified as obese and at risk from pediatric records, less than 10% of parents even responded and agreed to participate.

Three main reasons for this lack of concern include:

• Cultural acceptance of a large body size. We have known about cultural differences for years. African Americans and Polynesians are far less concerned about their appearance than Euro Americans. Even Caucasian Americans are more tolerant and accepting of larger sizes than in years past. (There isn’t much choice, as a majority of the population is overweight.)
• Lack of knowledge about the connection between childhood obesity and future health risk. Health risk associations are minimized in the public media; most of the associations made with high-fat food and obesity are about pleasure—not health.
• "Optimistic bias” in the perception of personal risk, which occurs when people minimize their own personal health risk. For example, we see other people as being at risk, but do not see ourselves as having a similar degree of risk. Being vulnerable can be stressful, which is painful, so avoiding reality allows for a calm, peaceful feeling that “all is well.”

According to the study, many parents have had no direct experience with chronic illness and find it difficult to associate apparently healthy children with poor health. Also, most parents had only seen public health campaigns directed at elderly or older people.

Many obese patients refuse to make real changes in the household because they don’t want to deprive their children. A typical question I ask a parent is, “Do you want to see your child sitting in that chair 20 years from now as a patient who I’m treating for obesity and its problems?” The answer is always “no.” Nevertheless, I can tell that parents really don’t perceive their children as sick—now or ever. Yet a sick child is a parent’s worst nightmare—at any age.

Optimistic bias! WOW! That really makes denial—well, optimistic!