Who cares
I don't know if the show is real or not.
I think it's a little of half and half. I think that some of the dialog is scripted, but I also believe that the restaurants that call MD do so because they have legit problems and want help.
But at the end of the day we don't know and can't know, but who cares?
Why does it matter if it's real or not? Why not just enjoy the show for what it is?
Or if you don't like the show and you hate it's concept, don't watch it. There are tons of shows that I despise and wish never existed but you don't see me gripping on about how much I hate them, why? Because I don't torture myself by watching them.
You hate this show? That's fine. Think it's stupid and a waste of air space? That's your opinion and your welcome to it.
Is it real? Who knows!
But real or not I find the show very entertaining and continue to enjoy watching it and hope to do so for a long time.