Too Big for 'Biggest Loser': New Reality Show Takes on Extreme Obesity

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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."

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