I honestly wasn't kidding. I ended with a joke, but I do believe that they actively choose eating over life. You can't routinely hear from a doctor, "You need to lose weight or you will die" and go home to more beetus unless your will to eat is greater than your will to live. It's addict behaviour in a way. Believe me when I say I hear exactly where you're coming from. I can't relate to not taking steps to correct failing health at all. They don't see it as suicide, though, which is why I disagree that they would choose euthanasia. I think the part of this you are missing slightly is the cognitive dissonance. When they are told they are going to die, they don't actually process it. My doctor told me my vitamin D was low and it scared me straight because I have forward thinking skills. Now my levels are good. Fats don't believe what they hear is real and I think this is because they won't believe it until they feel symptoms. As soon as the medication takes the pain or blood pressure away, they are back to thinking they have nothing to worry about. After all, burgers aren't inherently bad like taking a knife to your skin, and they've been downing them for decades, and they feel fine today, so why would they believe they need to stop or die? Combine that with the denial that says, "It won't happen to me" or, "I'm not that bad" and the fact that they have probably grown accustomed to feeling shitty and don't even notice that they feel bad and that's the "logic."  It sounds like a really deep and complicated issue, but my opinion is it's simple laziness. They don't change or improve because they can't be bothered. They don't believe they are going to die today or from this burger and so they don't feel the need to change. Lifestyle overhaul can be tricky and they would rather stay in their set ways and hope for the best, basically, than make the effort to really improve.  I don't think they actively want to die. I think it's more that they are too lazy to live.