In the competitive reality show "The Biggest Loser," which airs on NBC, contestants are sequestered on a ranch in Southern California, where they struggle with diet and exercise to shed pounds, always hoping they've lost enough to escape elimination at the next weigh-in.
The producer of that show is J.D. Roth, and he's also behind the new ABC series "Extreme Makeover: Weight Loss Edition," premiering Monday, May 30.
The focus is still on tackling obesity, but this time, the stay in the lap of luxury is brief, and then the participants fight the rest of their battles at home.
Sitting in the high-tech gym at the California Health & Longevity Institute, a wellness and medical facility attached to a Four Seasons Hotel in Westlake Village, Calif., north of Los Angeles, Roth looks around and says, "This isn't where they lost their weight. They spent one week here.
"The help that they got here allows them to use the nuclear option. If you're going to go on a show like this, it's all in. It's all or nothing, every single day.
"We have cameras in their houses. We check in on weekends."
Each of the eight episodes focuses on one superobese person (the highest starting weight was 651, and the lowest was 369) over a year.
They start at the institute for a "boot camp," which includes a complete medical work-up and nutrition education. They then return home, where trainer Chris Powell ("The 650-Pound Virgin") has turned a room in the house into a gym.
Powell stays with each participant for several weeks to get him or her started. Then they're on their own, with periodic check-ins, both at home and at the institute. Some do incredibly well; some struggle with themselves; others, with their loved ones.
In a way, the show is an answer to those fans of "The Biggest Loser" who grouse that anyone can lose weight if he's tucked away at a fancy ranch with top-notch trainers.
Roth admits, "It's tougher to motivate without the weigh-in every week, and that's presented some challenges. This show proves you can do it on your own, too."
While those who don't weigh well north of pleasantly plump may think these people suffer from some exotic malady that put them in this situation, Powell begs to differ.
"What (these people) have in common is no different than what we all have in common," he says. "For them, they deal with their emotions with food. That's it. I deal with my emotions, right now, I'm a workaholic. If you asked me three years ago, it was caffeine. I had way too much of it.
"What they encounter in everyday life is the same thing that we all encounter. They have issues that so many of us deal with. Food is the drug of choice. It could be sex; it could be work; it could be gambling."Powell believes that these people are dealing with a true addiction.
"Absolutely," he says. "They measured the chemical release in the brain when a food addict smells food. Sure enough, there's a similar kind of chemical release in the brain at the same time.
"Also, the amount of sugar we get nowadays in one pop -- our food has changed. That sugar elicits such a strong chemical response in the body. It is a chemical addiction."
Inspired by a seven-minute video in which one contestant, 651-pound James, struggles to just put on his socks, Roth doesn't just want to change bodies.
He says, "I thought, 'This is sad. This is a guy who's going to die, and he doesn't have to.' I went to ABC, and I said, 'What if we could give that guy his life back?'
"As much as this is a show about weight loss, it's really not. It's a show about people changing their lives."
That's one reason Roth came to the institute. It's more than just a well-appointed medical facility, wellness center, gym and spa; it also has a stated mission of sustainable change.
"If you transform (people) in a sustainable way, you've done something really, really great." says its medical director, rheumatology and internal medicine specialist Dr. Terry Schaack. "We believe if you can bring people, give them immersion for days or weeks, that you can actually give them the skill set, the knowledge base, then they can go home and incorporate that into their home lives and actually make sustainable change.
"We're not delusional. We know that not all of these people are going to continue to lose after 365 days, but many of them are, and many of them are going to maintain the weight they've already lost.
"That's a wonderful thing for us, that this is a sustainable change that this show has been able to help these people experience."