Fake. I like to be upfront, I saw for some reason a video come up on YouTube with a click-bait title “my 600 lb life exposed” where the lady claims she did her research and she’s concluded that it’s “real”. Well she’s wrong, and this entry will explain why she’s wrong.

So first off let’s set some parameters. Real would be a documentary, an investigative journalist report, a medical procedural show, a bibliographical programme, or perhaps an educational programme. At the lower end we might even accept a current affairs show. 600-lb Life is a reality television show that imitates the format of a documentary programme like Brother’s Keeper. Its imitation of the documentary format is as close as it gets to being “real”, the show is just entertainment, not an informative show. You could even call this kind of show “documentary-porn”. It’s what people watch instead of documentaries as documentaries are far less entertaining.

One reason why people might think that this show is real is because it has “real people” and claims to follow their journeys over the course of a year. But this is just a staple of reality television.

So why then is this show fake – what makes it fake? The number one difference between this kind of show and a documentary is that a documentary film-maker is there to tell the story that unfolds – they aim to represent people and their journey as they are, and to present the viewer with an accurate account of what took place condensed into the space of an hour or two. Reality shows instead of showing you people’s journeys, construct characters/personalities out of their participants and manufacture dramatic moments through the use of music cues, clever editing, and frankenbiting. Constructing personalities for your characters in single episode instalments is far easier than in ongoing serials – have a look at Ice Road Truckers for a counterexample and take notice of how those portrayed with “reckless” personalities have that toned down or even dropped in subsequent series!

They also create whatever story and whatever ending they want for their show and make it all fit within their show’s formatting. One huge difference you will notice between this show and any acclaimed documentary is that use of a voice-over by their participants. To create this voice-over the participants are primed with videos of stressful or emotional clips and a producer (or director) grills them with questions that both further prime them or are intentionally leading. So for example, when you hear someone say something like “this is my last chance and if I don’t get surgery I will die” a line that every participant I’ve seen so far appears to have uttered, it’s because someone has primed them or lead them to say that off-screen … or they’ve simply constructed it by frankenbiting (taking different parts of conversations and editing them together to create a completely new statement by their participant). And it’s not hard for them to manipulate these participants, as most of them have high anxiety associated with their weight, and when a producer or someone off-camera makes them uncomfortable they will do what the producers want in order to lower their anxiety.

The show does not address many of the issues facing the participants. It presents a very shallow view of weight management – there are many issues which these people face, however if it doesn’t fit the show’s manufactured format then they aren’t included. Social anxiety for example is one huge issue for many people with morbid obesity that prevents them from going into public more to exercise etc. Disordered eating is usually the result of a mental health condition, rather than the result of gluttonous behaviour and those issues are not addressed either. Instead the show simply views morbid obesity as the result of a person’s unwillingness to control their behaviour and the enablers that surround them. While that forms part of the picture, it’s far from a comprehensive understanding.

If someone fails to lose weight or to get surgery over the course of the programme they can construct whatever personality they want to present the viewer with. The blame for this is always on the patients and never on the healthcare providers who never seem to feel responsibility for the success of their clients. One example of this is an episode with a man named James K who they present as being a gluttonous slob. Never mind that he became bed-bound due to breaking his ankle, and probably feels high anxiety and humiliation due to it, which of course is going to make any effort to control his diet difficult. Cynthia on the other hand is portrayed as a strong independent woman raising a lovely family, but how different her episode would have been had she started bed-bound following a broken ankle! And that leads me to my next point…

The show presents unrealistic expectations on its participants. You think morbidly obese people can stick to a 800kcal or 1200kcal diet on their own? You have to be kidding me. And not only that, but every episode portrays bariatric surgery as the final goal of the participant – never mind the fact that it’s not suitable for everyone, and that people need to be assessed to determine whether they can lose sustained weight on a controlled diet on their own or whether they will require surgery. It’s not something suitable for all morbidly obese people. And nor is a 800 or 1200 kcal diet, to lose weight over the long term without surgery you would put someone on a energy restricted diet that decreased energy overtime as they lose weight – and you wouldn’t start anywhere near 1200kcal. In fact based on the shows portrayal of Dr Nowzaradan who consistently blames his patients or their family members for their ill health, and never seems to advise them that bariatric surgery may not be the right solution for them, I would think he should be investigated for medical malpractice.

Some participants are shown to be consistently losing weight, but then get surgery anyway. Um what? And worse still, in those episodes Dr Nowzaradan will say something like “they have done reall well but needs surgery to keep going and make progress long term”. No they don’t – many of them don’t need surgery at all. Bariatric surgery does not work long-term. It’s not a real solution, at least not for all patients. It can be a helpful tool, but that’s it. The idea that people need it or they will die, or that they can’t make progress without it is a complete fabrication and outright lie. If you watch the original series that was shot over the course of 7 years you will find that some of those participants (all of them by now probably) re-gain all the weight they managed to lose before and then after surgery. And that brings me to my final point.

The show’s successes are only an illusion. Here today, gone tomorrow. The show does start by saying that only 5% of morbidly obese people are successful long-term in controlling their weight, but they end many of their episodes by portraying a success that may be nothing but a short-lived false victory. The end goal for weight management is in 20, 30, 40 years time in the long-term, not in 1 year. 1 year means nothing, and if the show put that into context it might have a bit more medical credibility.

The show is fake, if you enjoy that’s perfectly fine. It’s an entertainment show after all, but stay sceptical and don’t take it seriously.