My experience has been that doctors don't actually even bother to recommend lifestyle change, they just vaguely cast aspersions on my lifestyle based on my weight and blood pressure, and that's the end of it.
Many doctors have given up on recommending lifestyle changes to patients because compliance is so poor. They see it as a waste of time and prefer to focus on interventions that seem more effective.
If you want to make lifestyle changes then it might be more useful to consult with a dietician, personal trainer, or therapist instead of a physician.
I believe many people don't follow those recommendations, because no one is told how. like lose weight and exercise - how exactly? There's a middle bit missing imho - an average joe's food and exercise centre if you will. personal trainers and nutritionists are next level in my experience, they're not really interested in telling average joe's walk a bit and do some exercises, same with nutrition - people need recipes that they can make easily, and healthy food they can buy when out easily. These things don't exist in my experience. The junk food industry is huge, as is the diet industry - saying do these easy things and you'll be sweet isn't really a money making proposition afaics.
Like anything, it’s a complex of the doctor’s personality, personal motivations and their own contentment or lack thereof and how it manifests in their work.
One of the finest bedside manners and wholistic approaches was a doctor I’d had growing up who moved up here from Kingston, Jamaica. The life he had led up until his career as a GP forced him to maintain a “big picture” approach.
One of the worst bedside manners and considerations is a doctor who I can’t name or point to because he’s one of rather high standing in Toronto. A truly brilliant physician and technologist. Awful manner, poor communication. That’s compounded in emotional effect as it’s your life on the line and not theirs.
People are complex and some doctors prioritize their work with patients, others prioritize their research, others their personal finances and so on.
If possible, it’s best just to seek out help and insight elsewhere. Sometimes that second opinion doesn’t change anything, other times it’s fundamental.
If you want to make lifestyle changes then it might be more useful to consult with a dietician, personal trainer, or therapist instead of a physician.