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.