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100% it's that. I've heard patients say it's just a power trip from the doctor, or because the nurses want your stomach empty so they don't have to clean up if you vomit. Some people have a weird interpretation of what "NOTHING BY MOUTH" means ("No I didn't eat - all I had was a handful of crackers / just one pancake / just coffee / etc")
Pre-op instructions are really bad about conveying why we give that instruction, which is a complaint I've made at every hospital I've worked at. So then the patient gets to the OR, and we're trying to give that lesson verbally, but they've already broken the instruction at that point. Easily the #1 cause of cancellations when that comes to light; but we do get the occasional moron who thinks we're just fucking with them or something or decides its worth risking their life instead of dealing with the hassle of rescheduling... there's some confirmation bias too: this might be the 4th surgery they've had where they ignored that instruction. Ate a full breakfast every time and nothing went wrong, so it becomes like a game to them. Then on #4 the odds catch up to them and suddenly they're digesting their own lungs.
I wish they'd have to watch like a 1m video animation showing what happens. The long list of do's and dont's gets understandably overwhelming.