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The "extreme" in this summer's new reality TV show "Extreme Makeover: Weight Loss Edition" doesn't necessarily refer to the tactics used by personal trainer Chris Powell. It's the severity of the obesity that makes this show different.
The eight contestants who will be the stars of the show were all turned away from another ABC weight loss show, "The Biggest Loser," because the intense workouts might have been a health concern. Effectively, they were too obese to compete.
While these particpants may have the most weight to lose of any reality TV makeover, the approach taken by "Extreme Makeover" may be the healthiest, most doctor-approved approach yet.
When you're tipping the scales at nearly 500 pounds, losing weight can be a matter of life or death, but so can extreme dieting or exercise, especially for those who suffer from high blood pressure or heart disease.
The "Biggest Loser" approach, with intense calorie-restriction and a competitive environment, "is not the way I would have most people lose weight," says Dr. Terry Schaak, medical director of California Health & Longevity Institute, which served as the backdrop to "Extreme Makeover: Weight Loss Edition."
The Institute offers an immersive weight-loss program that focuses on moderate, easier-to-maintain dieting, with a vigorous exercise program that can be gradually tapered down as the person reaches their ideal weight, Schaak says.
This is the basic approach taken on the show, on which eight participants lose a total of 2,600 pounds over the course of a year under the guidance of their "650-Pound Virgin" trainer, Chris Powell. Each episode will tell the year-long tale of a different participant's makeover journey.
Make no mistake, the makeovers were dramatic, with some contestants losing "north of 150 pounds in the first 90 days," says the executive producer of the show, JD Roth. But the fact that makeovers take place over the course of an entire year in the contestants homes, with participants often fending for themselves for weeks at a time, makes this kind of reality weight-loss makeover more likely to stick, says Dr. Keith Ayoob, associate professor in the department of pediatrics at the Albert Einstein College of Medicine in New York City.
"The longer weight loss takes, the more likely it is to be part of a lifestyle change, and that's when you have real weight loss. Too fast, and I guarantee that's going to come back," he says. "This game is won and lost in maintenance."
"Extreme Makeover: Weight Loss Edition," which premieres on Monday, May 30, was conceived as a way to tackle the weight-loss issues of the morbidly obese, but also to show a dramatic weight loss that didn't take place in the context of a secluded environment and under constant guidance, as on "The Biggest Loser."
"I kept hearing people say [of 'The Biggest Loser'], 'Yeah well if I had a trainer and a perfect ranch and a fridge full of healthy food, I could do that too!'" Roth says. "But I wanted to show that you don't have to suspend reality for you to get your life back. These people prove every week that with a little bit of hope and someone to hold your emotional baggage for you, that you can do that."
Indeed, the emotional ramifications of major weight loss often take longer to cope with than the weight loss itself, doctors note.
"It's about changing your mindset, because this type of weight loss is going to be life-changing, personality-changing for these people," Ayoob says. "People who are used to being nice and not complaining much, all of a sudden they find that they're not swallowing their emotions by eating, so everything's on the surface. It's an adjustment for them and for their friends and family."
Sometimes, the person the weight-shedder becomes is not who loved ones are used to, says Dr. Mitchell Roslin, a bariatric surgeon at Lenox Hill Hospital. When people lose significant weight through bariatric surgery, doctors have noted that there is a high divorce rate, manic episodes and even cases of hypersexuality, he says.
By focusing in on one person's full journey each episode, documentary style, "Extreme Makeover" will attempt to capture the full journey through weight loss, not just the high-intensity, boot-camp aspect of it.
"No one eats that much food because they're hungry," Roth says. "There are so many emotional layers to peel back. Anyone can do calories in, calories out, but it's all the other work that needs to be done: what went wrong, who you will be in your new life.
"These are people who had to keep their mattress on the floor because they broke every frame they put their bed in," he says. "So much of their life was turned off when we met them, and it's amazing how much can turn back on in just 365 days."