Medicalized reality weight-loss television and the negotiation of neoliberalism on My 600 Pound Life

Introduction

‘It’s definitely more than food, it’s like crack to me’. This line is from an episode of TLC’s Freaky Eaters (2011) titled ‘Addicted to Cheesy Potatoes’ (2008.2: 2). The woman featured on this episode, Kelly, eats only potatoes slathered in cheese for all of her meals, and has since childhood, resulting in her consuming almost three thousand pounds of potatoes and 15 hundred cups of cheese each year. Kelly says this compulsion to eat is why she is fat, or medically categorised as obese. Her uncontrollable eating of potatoes both inspires feelings of shame and the eating of her ‘ooey gooey’ food in secret, paralleling the typically reported behaviour of those addicted to illicit drugs. And Kelly is not alone in her experience, as each episode of Freaky Eaters follows a different self-described ‘junk-food addict’ with the same problem: an insatiable drive to eat their food of choice, whether pizza, cheeseburgers, maple syrup or corn starch. Although each episode of Freaky Eaters follows individuals as they attempt to change their behaviours by themselves or receive treatment from various experts, most participants do not achieve substantive change or feel relief by each episode’s end.

In addition to episodes of Freaky Eaters, a number of reality television series and special episodes over the years have explored the relationship between food and fatness. Some examples include Inside Brookhaven Obesity Clinic (2007), Big Medicine (2007-2009), What’s Eating You (2010), The Fat Doctor (2007-2012), The Man Who Ate Himself to Death (2013), Secret Eaters (2012-2014), Weight-Loss Ward (2014), episodes of Body Shock (2003-2014) and True Life-(2017), The Big Ward-(2018), 1000-Lb. Sisters (2020-), Too Large (2021-) and Obesity Med (2021-), among many others that circulate primarily in the United Kingdom, Canada, Australia, New Zealand and the United States. The longest lasting and most popular show in this subgenre of medicalised weight-loss reality television is My 600 Pound Life (2012), which is currently in its 10th season. These medicalised reality TV shows are part of an influx of different kinds of fat representations and weight-loss narratives across sitcoms, scripted dramas and reality TV series, which move away from depictions of extreme exercise and calorie restriction or dramatic weigh-ins (Zimdars, 2019). They also exist alongside other emerging reality TV subgenres and different kinds of ‘factual programming’ (see Hill, 2015) that may differently engage with neoliberal discourses, as I will show.

On their surface, medicalised reality television series about food and fatness, like My 600 Pound Life, seem to reinforce the same tired discourses of neoliberalism that have come to define our understanding of contemporary reality television as well as our current health, sociocultural and political contexts, particularly in the United Kingdom, Canada, Australia and the United States. These discourses and aspects of neoliberalism are thought to ‘thrive on the mediated pedagogies offered in and through reality TV’ (Weber, 2014: 27) because many narratives on these series perpetuate the idea that ‘failure is an individual problem and that success is based on the neoliberal principles of self-discipline, enterprise, and productivity’ (Boyd, 2012: 265). This is arguably the dominant theoretical lens by which television and media scholars consider and analyse reality television texts. What I am asking us to consider in this article is how these series negotiate neoliberalism and whether we need to expand our toolbox to better understand both the wide variety of emerging reality TV subgenres and how reality television still functions as television.

After surveying the literature on reality television and neoliberalism, this article will consider how medicalised reality television about food and fatness negotiate and decentre discourses of neoliberalism. I will then demonstrate how the medicalisation of reality television programmes about food and fatness work with theories of spectacle, specifically how the bodies and behaviours on these TV programmes can be engendering of sympathy as much or more than of discipline and shame. Finally, I offer a textual analysis of My 600 Pound Life. I do not claim this analysis to be a comprehensive analysis of all medicalised reality television about food and fatness, but I believe the textual examples discussed are representative of the hundreds of hours of reality television I have watched that has been produced and circulated on this topic since the mid-aughts.

Is reality TV neoliberal?

Discourses of neoliberalism advance the notion that one’s success or failure is determined by the individual and based on one’s own choices, hard work, enterprise, personal responsibility, or self-discipline (Barry et al., 1996). We are encouraged to rely on ourselves and our own choices rather than the state, reifying a socioeconomic and political context characterised by privatisation, deregulation, efficiency and reductions in governmental or social support services. In this context, our successes and failures are the result of individual choices regardless of the systems or structures, limitations or advantages, that we may experience or that may characterise our lives. Neoliberalism has, in many respects, become ‘common sense’ in that social problems are challenges for individuals to ‘overcome’ (Hoerl, 2002: 359) rather than for the state to address.

When media scholars began focusing on reality television as an area of scholarly inquiry, we tended to look at it in relation to neoliberalism (Miller, 2007; Ouellette, 2004) and related concepts like surveillance (Andrejevic, 2004, governmentality (Ouellette and Hay, 2008) and self-discipline, personal responsibility and individualism (Becker, 2006; Bratich, 2006; McMurria, 2008; Ouellette, 2004; Palmer, 2002, 2003; Sender, 2006; Weber, 2009). Reality television programmes are known for employing hidden camera surveillance, public humiliation and other controlling techniques to get participants to comply with the instructions of television experts (Ouellette and Hay, 2008). And in doing so, these shows are thought to teach viewers at home to be independent and self-disciplined rather than reliant on the state or the public ‘safety net’ (Ouellette and Hay, 2008). In other words, they teach ‘good citizens to take care of their own health’ while warning others ‘who fail to live up to socially constructed moral obligations’ (LeBesco, 2010: 78). These disciplinary techniques and messages to audiences are present on shows like What Not to Wear (2003–2013) and Extreme Makeover (2002–2007), among numerous others. Newer research on reality television continues to consider reality television in relation to neoliberalism (Hungerford, 2020; Inthorn and Boyce, 2010; Page, 2015; Patterson, 2015; Robé, 2015; Springer, 2014). For example, Kristen Hungerford (2020) argues that the show Undercover Boss reinforces notions of neoliberalism and the idea of the ‘American Dream’. In a non-United States TV example, Wei Luo (2017: 192) finds that Chinese state-media-produced reality dating shows ‘naturalize a regressive gender mandate in alignment with neoliberal values’. All of these studies, spanning over two decades, demonstrate the longevity and omnipresence of identifying neoliberal discourses, logics or ideologies in reality television content.

Despite the dominance of scholars identifying ‘neoliberal rationalities’ in reality television series and subgenres, Guy Redden (2018: 400) argues that ‘there is little sustained discussion of the relationship between neoliberalism and reality TV as an overall mode’. In his analysis of several reality TV subgenres, including makeovers and gamedocs, he states:

[t]he working proposition of this article is that reality TV is neoliberal, not in the sense that every aspect or variant of it can be explained through recourse to the concept, but that neoliberal logic is evident in both the main recurring textual features of reality programming and in the material conditions of their production (Redden, 2018: 400).

Redden and I agree that neoliberal logic is evident across a significant amount of reality television programming, but what I would like us to start exploring in more detail is exactly how and in what ways aspects or variants of these shows cannot be explained through neoliberalism. Instead, we might look at how these texts also serve to undermine or negotiate neoliberalism and associated concepts like governmentality, discipline or personal responsibility. We need to look at the way aspects or variants of these shows create tensions and negotiations, and how polysemy is inherent in reality television stories. Dana Heller (2009) urged us to think about how reality TV is dialectical and contradictory in exploring power and subordination, resistance and consent. Reality television is, after all, still television. John Fiske (1987) argued that representations contain as many contradictions as our social experiences, and that remains true today even if those representations and narratives are of the reality TV variety.

For example, Joe P.L. Davidson (2020: 487) notes the many ways by which survival reality television ‘departs from the general neoliberal tendency of reality television’ by depicting ‘the failed promise of neoliberalism’. I find this in my own research on globally circulated reality television series about weight-loss and fatness because they regularly expose their incapacities to consistently support disciplinary logics (Zimdars, 2015, 2017, 2019). Reality television functions much like power more generally wherein ‘the existence of strategies of power does not necessarily correspond with the successful exertion of power, and (…) intended outcomes often fail to materialize because disciplinary strategies break down and fail’ (Lupton, 1997: 102). Even though television may indeed govern at a distance and circulate dominant neoliberal discourses, the stories that we watch unfold on our screens still negotiate and destabilise those discourses, exposing the limits of individual choice, surveillance and discipline as a means to transform our bodies and behaviours. As television disciplines and controls, it simultaneously exhibits its own effectiveness to do either while creating space for alternative and often contradictory notions of health, fatness and the body. In other words, and like we have long understood, television is a polysemic medium of storytelling that can also contribute, however incrementally, to emerging and alternative ways of thinking about bodies, issues, events or contexts, among many other things.

One way in which My 600 Pound Life and other medicalised reality series about food and fatness differ from typical weight-loss reality series is how they often position themselves as documentary rather than reality TV. Although the differences between reality TV and documentary is largely a matter of extratextual discourses and framing (Murray, 2009; Mittell, 2001), this can impact the way viewers are encouraged to make sense of what they are seeing. My 600 Pound Life positions itself as observing the journey of participants as they go through a weight-loss programme rather than as the TV show itself being the intervention (even though the show pays for participants to travel to see a doctor and medical care is, reportedly, covered by the show). There are no celebrity hosts, fitness challenges or weekly eliminations. Instead, there is minimal narration by the participants themselves, on-screen text describing contexts and providing story updates, a series of mundane scenes of people sitting on couches, driving, lying in hospital beds and more spectacularised scenes of surgery, eating large amounts of food and the difficulties of cleaning wounds or after defecation. These aesthetic and narrative choices framing My 600 Pound Life and others like it as being more in the documentary tradition may encourage viewers to understand what they are seeing as less sensational or exploitative and, perhaps, even socially important or educational.

Medicalised fatness and shifting discourses of the ‘obesity epidemic’

There are different ways in which fatness is understood and constructed as problematic in the context of the ‘obesity epidemic’, and different types of reality television series are articulated to different discourses or framings of fatness. The most common framing of fatness is a health problem connected to personal responsibility and lifestyle choices (see Boero, 2012; Graves and Kwan, 2013; Saguy, 2012). These discourses or frames position fatness as the result of individuals failing to care for themselves and as requiring exercise and calorie-restriction for a weight-loss. Reflecting this, numerous reality television programmes focusing on fatness and weight-loss, such as (The Biggest Loser, 2004; Weight 2011-), do so by primarily advocating the necessity of individual change and working to shape individual behaviour through discipline under the guidance of physical trainers, nutritionists and other health ‘experts’ (Silk, et al., 2009; Palmer, 2014; Sukhan, 2013). Many of these shows follow the same general logics as other reality makeover or transformation series (Lewis, 2013; Palmer, 2014; Weber, 2009). However, even these TV programmes do not straightforwardly reinforce discourses of neoliberalism as they regularly depict the difficulty and failed promises of taking personal responsibility for oneself and of dieting and exercise for weight-loss. These programmes also regularly depict the failures of surveillance by experts and TV cameras to get participants to discipline their bodies into a thin ideal as weight-loss is depicted across many of these series as a difficult and ongoing process that only sometimes ends in ‘success’ (Zimdars, 2019).

An additional and increasingly common way of thinking about fatness is medicalised as a disease itself or in relation to other diseases like food addiction. Medicalised understandings of fatness are used to denote a particular kind of ill health, one that has its own ‘risk factors, typologies, outcomes, treatment, and prevention’ (Jutel, 2009: 63), yet remains a sign of or risk factor for future illness. Studies show that medicalised understandings of fatness or instances when fatness is discussed in relation to factors beyond personality and individual behaviour, such as food addiction, genetics, biology or the environment, reduce attributions of blame or perceptions of lacking personal responsibility (Lippa and Sanderson, 2012; O’Brien et al., 2010; LeBesco, 2010). Furthermore, the American Medical Association’s goal in labelling fatness a disease in 2013 was not only to reduce the stigma of obesity, but also to challenge the perception that fatness is simply due to over-eating or sedentary behaviour, and of course, to make sure more insurance providers cover procedures like weight-loss surgery (Pollack, 2013).

These medicalised understandings of fatness and disease complicate and challenge the idea that fat embodiment is just about exercising or overeating calorie-dense foods as our bodies are also influenced by medical issues, genetics, our environments and our food cultures. While television narratives about food and fatness similarly frame fatness as a problem in need of a solution, the solutions emphasised on these medicalised reality shows are different from diet changes and exercise; they instead focus on medical treatments, such as gastric bypass surgery and hospitalisation. The medicalised framing of fatness as a disease and centering of medical treatments that mitigate individual blame for behaviours and types of embodiments is particularly important for interpreting how reality series about fatness and food may function differently. How can someone be personally faulted for their addiction or for having a complex disease requiring medical treatment? Many of the assumptions that we have control over our bodies found across weight-loss reality shows like The Biggest Loser are thus called into question.

These medicalised explorations of food and fat embodiment reflect an expanding or shifting narrative of the ‘obesity epidemic’ (Shugart, 2011). At once, monologic understandings of eating practices and the size of our bodies as being the result of personal responsibility and discipline are negotiated and implicitly challenged by medicalised discourses. But more importantly for the argument of this article, the reality TV representations of the relationship between food and fatness in this context also require us to interrogate dominant understandings of how reality television functions to reinforce neoliberal discourses of personal responsibility and self-discipline. Both reality television and the ways we talk about fatness as part of the ‘obesity epidemic’ have long focused on individuals taking personal responsibility for themselves or self-discipline through diet and exercise in order to achieve a certain body size or specific health outcomes. But medicalised representations of food and fatness on reality television undermine these ideas as much as they operate in service of them. Instead, they tend to reinforce a different kind of discipline: the requirement of submitting to medical authority and medical interventions to ‘treat’ the fat body; however, and just like their earlier reality TV weight-loss counterparts like The Biggest Loser, they are still fraught with contradictions and weight-loss failures. Thus, the medicalisation of fatness does not erase discourses of control or personal responsibility over the body, and the televisual images and narratives on series like My 600 Pound Life still function differently and can foster sympathy as much as shame.

Food, fatness and sympathetic spectacles

Spectacle can mean the public exhibition or display of someone or something by those in power (Mendible, 1999: 74). Michel Foucault argued that the spectacle of the scaffold worked to ‘make an example, not only by making people aware that the slightest offence was likely to be punished, but by arousing feelings of terror by the spectacle of power letting its anger fall upon the guilty person’ (Foucault, 1995: 58). The spectacle of the bodies and behaviours on reality television series are thought to demonstrate ‘the subject’s need for intervention’ (Weber, 2009: 97) or so that they may be ‘regularly mocked as symbols of indulgence and moral decay’ (Palmer, 2014: 303). In this sense, they are thought to reinforce notions of discipline, or to shame individuals as a means to control them and to convince viewers of the necessity for them to self-control (Silk et al., 2009).

While spectacle could theoretically transform the ‘many-headed mob into an ordered crowd’ (Bennett, 1988: 85), Foucault (1995: 59–63) notes that it was not uncommon for people to also reject this kind of punitive power, sometimes trying to thwart executioners or attempting to free prisoners, further arguing: ‘It was evident that the great spectacle of punishment ran the risk of being rejected by the very people to whom it was addressed’. The resistance and revolts that Foucault details reminds us of the importance of considering the multiple ways in which we can read or react to not only public events, but also to what we see on our television screens, particularly the spectacular positioning of fatness or food addiction.

Not only can spectacle be rejected, I argue that it also functions differently on medicalised reality television. While the display of bodies is considered a disciplinary feature across reality television, Hannah Frith et al. (2014) argue that shame and humiliation are not the only ‘affective drivers’ of these programmes. Furthermore, Jennifer Fremline (2008) contends that the televisual gaze can be both punishing and a source of pleasure and arousal for viewers. More specifically, John Jervis (2015: 101) points out that sympathy has long been implicated in spectacle, arguing that we as humans generally do not feel good about the suffering of others, but we do feel good about our ‘capacity to respond sympathetically to the other’s suffering’. For Jervis, the sympathy response is likely when a ‘basic dimension of human suffering comes into view’ and when there are no questions of blame (2015: 7).

Across weight-loss reality television, fat individuals are regularly portrayed as suffering, but participants are almost always framed in terms of being personally responsible for their fatness (even if weight-gain is contextualised as following the experience of a traumatic event), or as being ‘to blame’ for their bodies. However, in the case of medicalised reality television about food and fatness, personal responsibility is negotiated because it is medicalised and participants’ stories are framed in relation to disease. Since the disease label mitigates personal blame, I argue that it also mitigates spectacle’s function as shaming or disciplining by fostering sympathy and different types of affective investment. Since participants on medicalised reality series about food and fatness are depicted as suffering from medical disease rather than from a personal failing, participants may thus be viewed as in need of compassion and help instead of discipline or making them feel ashamed. Blame ‘directed as outside the self” does not seem ‘weak’ (Palmer, 2014: 302) when participants are struggling, near their breaking points, and when they are already seeking help or treatment for various medical issues. Ultimately, because these reality television series deal with medical issues and fatness as a disease (as well as stories of personal trauma, physical impairment, and social disability) rather than individuals lacking self-discipline or willpower, the spectacle of both participants’ bodies and behaviours also functions to frame them sympathetically and compassionately in addition to – or even more than – shamefully or as evidence of needing discipline.

Although My 600 Life and similar medicalised realty shows reinforce the necessity of medical treatment and intervention, in addition to the need for participants to diet and exercise, they are similarly fraught with contradictions, and similarly exhibit the failures of bodily interventions and transformations as the reality TV shows articulated to dominant discourses of the ‘obesity epidemic’. So, while medicalised discourses of fatness can also be punishing, objectifying and problematic in other ways (Wheatley, 2016: 174), and the medicalisation of the body and submission to medical authority creates its distinctive modes of disciplining and enacting power (Foucault, 2003), they can also negotiate and challenge neoliberal discourses related to both reality TV and the ‘obesity epidemic’ in important ways.

Medicalised reality TV: My 600 Pound Life

My 600 Pound Life debuted on TLC in the United States in 2012, with episodes also airing internationally on TLC’s international channels and via streaming on Discovery+. My 600 Pound Life consistently averages around one million viewers per episode in the United States and has at times been the number one watched programme, with 1.8 million viewers, among women during its day and time slot (TLC, 2017). Each episode of the series is 2 hours in length and follows the year-long journey of someone seeking and sometimes undergoing medical treatment for weight-loss under the guidance of Doctor Nowzaradan, who is a bariatric surgeon.

Episodes of My 600 Pound Life start with participants narrating their stories while the camera depicts them lying in bed – zooming in on skin sores and lymphedema swelling – showering or being bathed, shopping for food and eating food. These opening scenes serve to introduce viewers to the backgrounds and life experiences of participants. Many of them talk about how they turned to food to ease emotional or psychological stress stemming from childhood trauma or abuse, or to cope with the deaths of loved ones or divorce. For example, Lacey (2021.10: 5) talks about being sexually assaulted as a young girl and how she used food to cope with the trauma she kept secret from everyone. She also talks about being bullied in school, which she says was because of her high weight and which became another cause for additional weight gain.

In addition to discussing their backgrounds and life experiences, participants also detail their past and current medical struggles while spectacular images of open sores, skin rashes and large sometimes-leaking masses fill the television screen. Many of the ailments and conditions listed by participants are commonly considered obesity-related diseases, and they reinforce the medicalised nature of the kinds of fat embodiment represented by these reality series. For instance, Samantha is introduced on My 600 Pound Life as dealing with a long list of medical problems, including high blood pressure, blood clots, diabetes and arthritis (2020.9: 1). Nathan has severe lymphedema and an open sore on his leg that will not heal (2021.10: 1). Lisa struggles to keep the skin between her folds clean and discovers the presence of maggots in a hard-to-reach and hard-to-treat wound (2018.6: 7). Like the links created between medicalised eating and experiences of trauma, especially childhood trauma, these medical struggles are framed as exacerbators of medicalised fat embodiment. Due to the physical impairment and social disability experienced by many of the participants on My 600 Pound Life, many participants share that they feel isolated and lonely, with eating food the one way by which they can find pleasure, fight boredom, or forget about the direness of their situations, even if just for a few moments. Thus, many participants’ relationships with food are framed initially as a kind of coping mechanism, consciously or unconsciously, and one which gradually becomes compulsive or uncontrollable, taking over and interfering with – if not threatening – life itself.

This uncontrollable eating is often medically framed in terms of disease, specifically food addiction. Nearly all of My 600 Pound Life’s 134 episodes detail participants’ stories about how eating food dominates their thoughts and activities every day. One participant, Randy, details his experience of food addiction:

When you’re my size, food is an addiction. When I crave it, I don’t want to hear what anyone else thinks. Everything tastes good, but you never get that full feeling and you just want to keep going. I wait till everyone is out of the house and I go eat whatever we just bought that’s in the kitchen, too. Nothing else exists while I’m eating. Everything else just fades away for a few minutes and when it stops, I’m just looking for the next time I can eat (My 600 Pound Life, 2016. 4: 10).

Similarly, and while the camera pans across multiple dinner plates full of ‘junk food’ about to be eaten, another participant on My 600 Pound Life, Aaron, says of eating:

Food has become an addiction for me (…) you gotta have that fix. And for me, it’s food. There is never a moment where I don’t want to eat, but as soon as I’m done eating, I’m already hungry for something else. Most days all I do is sit around and eat (My 600 Pound Life, 2019. 7: 12).

Randy’s and Aaron’s introductory stories about their relationships with food are far from unique on My 600 Pound Life. While eating a plate of waffles covered in syrup and whip cream, Janine also says:

I’m a sugar addict for sure. Sugar rules my world whether I want it to or not. I just can’t stop myself at this point because nothing feels as good as when I have that taste in my mouth. And when I’m done, I already can’t wait until my next meal” (My 600 Pound Life, 2018. 6: 2).

Finally, Nathan also details his experiences of food addition while the camera depicts him sitting on chair with a low-angle shot that emphasises both his large size and the large size of his lymphedema mass:

There isn’t a moment where I’m not craving something to eat. No matter what I’m facing, food always makes it better. It’s my relief. My comfort (…) When I’m eating it’s euphoric. It’s a feeling of relief from whatever negative emotion I have at that time. Even when I’m full, I keep eating and eating because that craving never goes away (My 600 Pound Life, 2021. 10: 1).

While these episode introductions may function to position fat individuals as ‘symbols of indulgence and moral decay’ on shows like The Biggest Loser (Palmer, 2014: 303), medicalised reality television shows like My 600 Pound Life that explore eating pathology, compulsion or addiction also frame participants’ behaviours and embodiments as medically dire and in need of treatment and medical intervention rather than increased self-control or discipline. Whereas ‘lifestyle formats that target the large’ tend to focus on individuals taking responsibility for themselves and frame ‘blame directed outside the self’ as ‘weak’ (Palmer, 2014: 302), My 600 Pound Life and other medicalised series do not position participants as ‘weak’. Instead, they are shown to be suffering both physically and emotionally as their entire lives become about changing their relationships with food via medical treatment. These participants do not need to be convinced of the need for change or shamed into consenting to change like other makeover or transformational reality series (Roberts, 2007) they already know that they need help. Many participants break down in tears during their first meetings with Doctor Nowzaradan, exemplified by Margaret sobbing and pleading, ‘Just please help me’ (2021.10: 10). Many of the participants believe – and Doctor Nowzaradan affirms – that without medical intervention they may not be alive much longer.

Each participant’s journey for a medical consultation is another way by which sympathy is fostered through spectacle as much as or more than shame on medicalised reality series. For example, Samantha (2020.9: 1) weighs around 800 pounds and is unable to go up and down the stairs of her second-floor apartment, making it impossible for her to travel from Denver to Houston for treatment from Doctor Nowzaradan. While trying to find a medical transport company willing to take her on the long journey, Samantha experiences tightness in her chest and water retention, worrying her enough to call emergency services. The following scene depicts a dozen emergency responders working on getting her out of bed and into a bariatric ambulance. This kind of scene plays out again and again on My 600 Pound Life. Many participants describe the humiliation they experience having to be ‘removed’ from their homes by firefighters and paramedics. Other participants cry and express the embarrassment they feel being stared at when navigating airports and other forms of transportation that are not designed for people their size. These kinds of situations where participants express their feelings of shame and experiences of social stigmatisation can actually interfere with ‘effective obesity intervention efforts’ (Puhl and Heuer, 2010).

Once participants on My 600 Pound Life and similar medicalised reality shows make the trip to see a medical doctor for treatment, they are always instructed to lose weight through restrictive dieting and physical activity, even if that physical activity takes place in the bed or on the couch. Doctor Nowzaradan usually frames this step as a way for participants to ‘prove’ they are able to follow a 1200-calorie, high-protein, low-carbohydrate diet plan, arguing that it increases their chances of losing weight following bariatric surgery. However, pre-surgery weight-loss difficulty is common among many participants, with some requiring, according to television physicians, hospitalisation with strictly monitored diets. For example, Randy (2016.4: 9) is able to manage his food addiction for a month and loses a small amount of weight, but he is told by Doctor Nowzaradan that it is not enough and he needs to lose more prior to being approved for surgery. During this second pre-surgery period, Randy struggles with his food addictions and is shown both making repeated trips to the fridge and making exceptions with his strict diet, eventually gaining back 14 pounds within a matter of weeks. Randy is eventually able to adhere to a strict diet through in-patient treatment, and so, 6 months after his initial consultation, he is approved for surgery. Although Randy was eventually able to lose weight to qualify for surgical intervention, a number of participants never leave this ‘stage’ of treatment for the duration of their episodes. For example, Angela (2019.7: 15) is unable to lose enough weight to ever ‘qualify’ for surgery, and ultimately decides she is not willing to uproot her entire life and be away from her family to attempt to qualify for surgery in the future. Lisa (2018.6: 7), Mercedes (2019.7: 18), Gina (2020.8: 5), and Lacey (2021.10: 5), among many other participants on My 600 Pound Life, never qualify for surgical intervention as a means of treatment.

In later seasons of My 600 Pound Life, when participants have difficulty losing weight to qualify for surgery, Doctor Nowzaradan refers them to ‘psychotherapy’ so they can address their ‘emotional pathologies’. Talk therapy scenes generally show the participants repeating their introductory stories to a counsellor who recommends vague advice about overcoming life’s challenges. Usually, only one therapy scene is shown per episode – although sometimes participants refuse to go to therapy entirely – and it’s unclear whether ongoing therapy becomes a part of Doctor Nowzaradan’s treatment plans.

Hospitalisation thus becomes necessary for weight-loss because diet and exercise recommendations can be difficult to follow, especially when struggling with food addiction, psychological and emotional issues (that one session of televised therapy seems unable to help), or physical impairment affecting one’s mobility. Hospitalisation proves to be a useful treatment option for some participants, such as Randy (2016.4: 9), yet not for many others. Even with the constant surveillance of the hospital setting and presence of television cameras, food addiction proves exceptionally difficult to treat. On one episode of My 600 Pound Life, Kelly (2019.7: 13), refuses to consent to a controlled diet and frequently orders hamburgers and other foods that are prohibited under Doctor Nowzaradan’s diet recommendation. Similarly, J.T. (2020.8: 4) fails to lose weight while admitted to a rehabilitation facility for 2 months because he continues to bring in outside food. And Kelly and J.T. are far from alone as Schenee orders pizza and burgers to the hospital (2018.6: 13) and LaShanta is actually shown hiding fried chicken under her blanket while filming her episode (2019.7: 16). During a 6-week stay in the hospital to monitor other medical issues, Samantha gains 140 pounds, bringing her total weight to 940 pounds (2020.9: 1).

These eating habits and food hidings occur despite the surveillance and control of the hospital setting, despite the presence of television cameras and the prospect of future TV viewers, and the fact that participants know they have upcoming weigh-ins. None of these things are alone or together enough for participants to be on a straightforward path of treatment for their food addictions and medicalised fatness. In other words, these typical disciplinary mechanisms embedded in the very nature of reality television are no match for many participants’ medical struggles. These example of the insufficiency of constant surveillance operates much differently than other programmes focusing specifically on fatness, which according to Gareth Palmer (2014: 313) in his analysis of ‘large bodies’ on reality weight-loss shows, tend to ‘offer proof that an increase in surveillance is effective in that nearly everyone loses weight and becomes happier in the process’.

Not only do reality television programmes about food addiction and fatness negotiate this ‘proof’, but the seriousness of each situation coupled with the lack of medical relief works to foster sympathy as much as shame for the medicalised TV participants who struggle with treatments for disease. Food addictions are especially tricky because people need to eat to live, they cannot just give up food entirely, although a few participants do either to qualify for surgery or to demonstrate weight-loss progress post-surgery. To demonstrate his willingness to take responsibility for his health and in an overcorrection for his previous weight-gain ‘failures’, Randy almost stops eating entirely to control his food addiction (2016.4: 9). This leads to medical complications with his heart, a trip to the emergency room and the determination that he is malnourished. After this health scare, Randy decides that he is going to slow his weight-loss and find more balance, but he’s scared that if he allows himself to eat anything that he will go back to eating everything, to eating how he did prior to his weight-loss surgery, unable to manage his relationship with food. The episode concludes with Randy developing a ‘healthier’ relationship with food, saying that he has about 200 more pounds to lose, but that he is hopeful. However, as detailed in an episode follow-up, after the cameras stopped rolling, Randy experienced a relapse in his food addiction and began regaining weight, which is an all-too-common experience on medicalised reality television series exploring this issue. Episodes of My 600 Pound Life almost never end with viewers witnessing a ‘pay off’ of a bodily or behavioural transformation, which in this case means participants being cured’ of their addictions and having lost weight or at least on the path of consistent weight-loss. Thus, and unfortunately for these participants, medicalised framings of the relationship between food and fatness as requiring treatment do not always result in positive health outcomes any more than other weight-loss reality TV series. In fact, some participants do not lose weight after undergoing bariatric surgery – and some even gain weight like Bethenny (2020.8: 3) and Nathan (2021.10: 1). The long-term ineffectiveness of bariatric surgery is discussed in the spin-off series, My 600 Pound Life: Where Are They Now (2015) and even in some episode introductions. In fact, each episode of the series opens with white text on a black screen saying, ‘Their chances of long-term success are less than five percent’. And several participants on My 600 Pound Life previously underwent weight-loss surgery only to gain back hundreds of pounds, which is the case for both Lee and Rena (2018.6: 1). Other participants meet an even grimmer fate than not losing weight. Two participants have died while filming, Robert (2018.6: 8) and Kelly (2019.7: 13) and two more died shortly after filming, Lisa (2018.6: 7) and Coliesa (2020.8: 12). The deaths of these participants, of which there are several more, reinforce the different, medicalised relationships between food and fat embodiment, between fatness framed as a disease rather than a lifestyle choice or matter of personal willpower, self-discipline, or self-control.

As previously mentioned, although lifestyle reality television series regularly depict a before and after, or bodily transformation, by each episode’s end, addiction is not something that can just be easily or quickly ‘treated’ or ‘solved’; rather, it is an ongoing, often lifelong process characterised by progress, stasis and setbacks. Some of the episodes of My 600 Pound Life exhibit moderate weight-loss ‘success’, but again, others end without participants losing weight or healing their addictive relationships with food. There is therefore no moment in these episodes where participants ‘revel’ in their new bodies or transformations or ‘proof’ that the logics of these shows work and should be adopted by viewers at home. Across these television examples, participants are not depicted as ‘basking in the visuality she or he once avoided’ (Weber, 2009: 82). There is no weight-loss ‘after body’ to present to the camera as evidence that medical treatments and interventions worked any better than the more common, personal-responsibility-focused recommendations of diet and exercise.

The medicalised representations of fatness on My 600 Pound Life differently represent fat bodies to the point where the typical reality television prescriptions (or cliché advice) of weight-loss through self-disciplined exercise and calorie-counting are no longer thought to be possible. Instead, both food addiction and fatness are framed as a matter of life or death, requiring serious or long-term medical treatment. The severity and desperation often associated with these issues add a layer of sympathy to a state of being that is otherwise positioned and perceived as shameful. Ultimately, the participants on My 600 Pound Life are also represented sympathetically, compassionately, and even tragically as much as or more than they are positioned as ‘to blame’, in need of shame, or as lacking personal responsibility for either their relationships with food or for their fatness.

Conclusion

My 600 Pound Life is the focus of this piece, but in many ways, it is not unique in how it tells stories of medicalised fatness. Participants on Freaky Eaters, Too Large, Obesity Med, and other series similarly talk about how medicalised fatness and food addictions or compulsions to eat challenge people’s relationships and basic aspects of everyday life. A True Life episode, ‘I’m Addicted to Food’ (Addicted to Food, 2011. 13: 20), opens with Alisha describing her relationship with food: ‘It consumes and controls my entire life (…) it’s ruining my life the way drugs do for everyone else’. And just like My 600 Pound Life, Freaky Eating cameras then follow participants as they try to refrain from eating maple syrup, corn starch or whatever they may be drawn to while exploring medical treatments. Also just like My 600 Pound Life, the surveilling context of the hospital and presence of TV cameras is no match for participants on Inside Brookhaven Obesity Clinic and other series where participants are similarly shown ordering ‘banned’ foods for delivery while confined to their hospital beds. In fact, one of Brookhaven’s medical doctors breaks the fourth wall and tells the camera crew, ‘For many, however hard they try, they simply cannot control their addiction to food. We can’t just say ‘no food in the building’ (…) we can’t lock everybody up’ (2007.2: 5). Finally, and again just like My 600 Pound Life, participants across medicalised reality shows about food and fatness experience ups and downs, reach some goals and then experience setbacks, with almost no one ‘cured’ by each episode’s end. Repeat hospital admissions with ‘controlled’ diets, surgeries, and other forms of medical treatment rarely seem to lead to short or long-term weight-loss across any medicalised series about fatness.

My 600 Pound Life and these other medicalised reality television series do sometimes reflect neoliberal discourses of personal responsibility, but they simultaneously challenge notions of personal responsibility and discipline through the retelling of heart-wrenching personal stories, spectacular visuals, and the rhetoric of disease. These medicalised discourses as circulated by television also offer competing understandings of fatness as being beyond self-discipline and self-control, mitigating dominant assumptions and stigmas about fatness signifying laziness or a lack of willpower in the context of the ‘obesity epidemic’. Yet while medicalised reality shows about fatness challenge the neoliberal logics of personal responsibility through exercise and calorie restriction found elsewhere on TV, they also exhibit an alternative framing of treating fatness that usually fails as well.

My 600 Pound Life demonstrates the need to complicate or expand how we currently think about the relationship between reality television and neoliberalism. The reality television series discussed here reinforce but also undermine reality television’s ability to govern at a distance (or teach viewers at home to self-discipline rather than rely on the state). These series demonstrate that being under constant surveillance of the television camera – while also under the surveillance of medical professionals or in hospitals – does not straightforwardly help in changing one’s behaviours or achieving particular health outcomes. Ultimately, these medicalised reality shows about food and fatness and other emerging reality TV subgenres or types of factual programming (like the survivor reality TV analysed by Davidson), require us to keep expanding our understandings of how reality television functions while not losing sight of foundational theories of television as being full of contradictions, competing discourses, and as engaging with both power and resistance. We need to explore what these shows reflect, reproduce, negotiate, and challenge as well as the health, sociocultural, and political contexts in which they are created and watched.