Like most reality TV shows, like most TV shows, like most storytelling, period, TLC’s My 600-lb Life depends on a certain predictable, unchanging format. But the specific way in which this one expresses its repetitiveness is uniquely depressing. The pattern approximately mirrors the tradition of celebrating Fat Tuesday just before Lent in cities like New Orleans: a period of profane overindulgence is followed by a period of ascetic fasting. Though fasting, in the case of the show, refers both to the literal definition of the word (as in abstaining from certain quantities or types of food) as well as a looser definition by which the effects of a fast are attained via surgical intervention.
None of which is to say that watching the show’s star, Houston surgeon Dr. Younan Nowzaradan, and his weight loss surgery-seeking patients at or above the title weight is any less addictive than scarfing down a box of Twinkies chased by some soda pop.
The show, which has been a fixture of TLC since debuting in 2012, has made a meme-worthy cult hero out of the star surgeon, widely referred to as Dr. Now. It has also recently birthed a heftier-sounding but essentially identical offspring, The 6000 Lb Diaries with Doctor Now, on Lifetime. Over untold episodes, both series have painted a portrait of a nation consisting in large part of the constantly renewing ranks of the morbidly obese.
(Courtesy of TLC)
Episode after episode, we make the acquaintance of people who have eaten themselves to a state of corpulence. Perhaps their obesity has some genetic, familial, or even traumatic origin. But by the time the cameras have turned to them, they are, literally if not seriously, fully grown adults with the capacity to make better “food choices,” to adopt the parlance of the show. Even so, most of them proactively worsen their condition by subsisting on fast food, whether obtained through the drive-thru lane or deposited at the front door, or, at minimum, on greasy food fried up at home.
To judge on their daily diets presented on-camera, these people are overweight in approximately the same manner that certain populations are homeless — voluntarily. Then, when their health begins to show evidence of real decline, or their mobility becomes too poor, they procure the services of Dr. Now. Plainly, what they want is a bailout in the form of a gastric bypass operation.
No episode can ever be considered inspiring, even those that end with something that resembles a success story — that is, a surgery that is accompanied by noticeable weight loss. That is because we know before the current episode ends precisely where the next one will begin: with another greatly overweight adult unable to break the habits that are sure to keep them in their present condition until, one day, they seek what many seem to regard as the quick-and-easy fix of weight-loss surgery.
In some ways, those featured on the show are literal gluttons for punishment: After satiating every appetite, craving, and palate preference, they seek atonement in the form of Dr. Now’s opprobrium and gospel of gastric bypass. In television terms, there is a not-unentertaining Odd Couple-like dynamic between the scowling, relatively trim Dr. Now and the caravan of pleading, bedraggled-looking patients who trek to his office in Houston.
If they have to travel from somewhere far-flung, as they often do, their journey has the quality of a pilgrimage. In this instance, the overweight hero can mark their destination by stepping onto the scale in Dr. Now’s office. Predictably but never less than tragicomically, the readings often do not align with the patient’s expectation of his or her own weight. The nurses then usher the stunned patient into the examination room to wait for Dr. Now. He invariably opens with the deceptively ingratiating greeting “Hello — how y’all doin’?” before beginning what must feel like an interrogation. Eating habits are scrutinized and sometimes attacked for their improbability given the patient’s present weight, and those accompanying the patient in the office, a spouse, friend, or parent, risk being labeled “enablers” depending on whether or not they are the ones who gather all that food for their loved one.
At this point, many start to realize that the sought-after surgery is not imminent — far from it. Sensibly, Dr. Now will require initial bursts of weight loss by conventional means of diet and moderate (intensely moderate) physical activity as a necessary precondition to being approved for surgery. These methods seldom pay off in the short term because the diet regimen is usually finessed or ignored. But when they eventually do, I find my sympathies shifting from Dr. Now to the patient. I ask myself: Since these people are losing weight without undergoing a gastric bypass or some similar operation, why not, um, continue doing it the old-fashioned way? You’re losing weight — keep at it! It seems to me that this is both a logical question and a fair one, but it goes against the grain of the show and the medicalized culture from which it sprang.
Like Judge Judy and Dr. Phil, Dr. Now’s censorious persona is largely responsible for his grassroots appeal. His sayings have found their way onto T-shirts and mugs, including “There is no protein in mashed potato,” and his range of reactions, disbelief, annoyance, and stunned silence, at the litany of excuses and rationalizations he hears daily, must be regarded as righteous. At the same time, there is something a little unsavory about all this emphasis on weight loss. If you will pardon the pun, binge-watching My 600-lb Life has the strange effect of making the overweight subjects seem less objectionable than the degree to which their overweightness is regarded as the essential feature of their humanity. When patients fail to lose weight, they are often referred to “psychotherapy” — truly cringe-inducing sessions in which being fat is yoked to all manner of personal problems. Undeniably, many of these people have problems, but don’t all people have problems? Didn’t all people always have problems? You can overeat and have had a horrible childhood, and the two need not necessarily be related.
Yes, Dr. Now is right to excoriate the habits he encounters, but some of his shows’ most memorable moments come when his patients challenge him and, implicitly, the whole regime they have signed up for. Consider one man who had gastric bypass surgery who pushes back at Dr. Now for telling him he hasn’t lost enough weight: “I don’t eat a third of what I ate before I had that surgery! … I throw up constantly. I eat what I can keep down!” This is a good point: Weighing 600 pounds is a very bad thing, but there are costs to losing that weight through surgery.
Or consider the woman who sarcastically jabs her significant other for losing a ton of weight even as she struggles: “You only eat like one strip of bacon. … It must be nice to take two bites of food and be full.” This, too, is a sophisticated perspective: When does a diet, however urgently necessary, become so draconian that it saps the savor of life? At another point, while eating a meal of microwaved hot dogs sans buns, this same woman asks him, with a smile that she hopes will break through his steely new skinny demeanor, “Who are you? I feel like you’re not even my husband anymore.”
Who are we indeed? To judge on the basis of Dr. Now’s two series, we are addicted to food, addicted to medical interventions to combat our addiction, and addicted to watching these addictions play out in the grotesque realm of reality TV. Clearly, there are numerous pathologies baked into this high-carb cake: our lassitude, our indulgence, our faith in anyone called “doctor,” our inability to turn from a car wreck. I would say “a plague on both their houses,” and that includes any house with a cable connection, including my own, set to receive transmissions from this American underbelly of excess and sadness.
Peter Tonguette is a contributing writer to the Washington Examiner magazine.