Watcher beware! This show has at least one graphic surgery per episode, generally lasting several minutes. My 600-Lb Life is sponsored by the medical center where they take place; suffice it to say the editors spare no details.

This program is focused on demonizing, then rehumanizing, an already traumatized set of people. I am not including images because, frankly, the exploitation is the most horrifying part.

What hooked me was the fact that everyone carries it differently. While every protagonist is so heavy that it’s actively endangering them, there’s a surprising amount of variety among body types. Some folks look like pupated Tim Burton characters, some have only a massive spare tire. Consider the poor woman whose lymphedemas meant her lower body outweighed her upper body 2:1, or the man whose cellulite was so prone to infection that it was constantly leaking and hardening.

Every episode begins with the featured patient describing how humiliated they are with themselves, then moves straight into discussing the generally similar traumas they’ve encountered, in between ECUs of the protagonist eating junk. The stars almost universally express that they know they lack control and are afraid of truly examining why. Bariatric surgeon-cum-producer Dr. Nowzaradan enters to offer a miracle cure in the form of stomach stapling. Based on their attitude, he performs the surgery or doesn’t.

Exploitation is an ugly, ugly storytelling device, and My 600-Lb Life makes certain that the audience only relates to its characters out of empathy they’re not entirely sure to trust. I’d estimate about two thirds of the featured people are sexual abuse survivors; while all of them clearly wound up with eating disorders, there’s no other common thread between them or likeable, individual trait given any real focus. My heart hurts most for the man who began eating badly after his first wife was murdered: halfway through the episode, his second wife and their toddler walk out over his “attitude problems”. It’s unclear whether we’re meant to sympathize with a man still obviously grieving or a woman whose spouse mentally abandons her as he does so.

I am featuring My 600-Lb Life because lack of control is probably my biggest, most realistic, and most relatable fear. Despite its simplistic sideshow sheen, this is ultimately a program about people who freely express that they live in a nightmare… and who, as often as not, don’t get to leave it.