You ask how hard can it be to do something? Well, I do not want to defend the MLCer but how many people do you know who are very overweight? And the solution for most people [I know there are some genetic conditions] is to eat a better diet and exercise more. And yet they remain fat.
Well that is the only way I can understand it. They see there is a problem and it could be fixed but not easily and not without effort.
I also agree that PA people have a fear of therapy because they hand over control [in their eyes], and also because the patterns by which they have lived for so long, and which they see as essential to their survival, are likely going to be challenged. They cannot really see the possibility of it improving
