is this the most exploitative reality show?

Yes, it is. The dialog on the programme is those fat bastards lamenting their bad choices and misfortune, but what the viewers really want to see is those flabby flab-flabs flabbing around on-screen. They don't care about the people themselves, and that surgeon (who's made a FORTUNE on the concept of the show) is making a name for himself by shamelessly exploiting them in the name of "helping".

Try 7 Little Johnstons. They literally have cut-scenes of the family dancing like oompa loompas. Every episode finds some sort of excuse to get one of them into a costume or do a ridiculous tik tok.