Who benefits most from weight-loss TV shows?

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“You’ve got to prove you can do it on your own, in the same environment that got you fat,” Roth says. “The stakes are real. The stakes are life. It’s not a million dollars or some contrived prize.”

“Makeover” participants first spend a week at the California Health & Longevity Institute, a state-of-the-art facility that blends medical support with cooking classes, fitness training, healing arts such as hypnosis and spa treatments. They’re led by Chris Powell, an Arizona-based trainer best known for helping 650-pound David Smith drop more than 400 pounds naturally.

His main focus with clients? Overcoming past emotional trauma and rebuilding their personal integrity and sense of self-worth.

“Until that, it’s just weight loss that’s being forced,” says the 33-year-old Powell. “Until they deal with those emotions, it will never stick.”

The subjects are shown facing setbacks and the emotional roadblocks that contribute to their dangerously overweight condition. After building trust one on one, Powell persuades participants to bare their souls on camera, telling them, “There are so many people that are suffering just like you.”

Roth says he created “Biggest Loser” because he is fascinated with human transformation, and he created “Makeover” to help those who are too heavy to qualify for “Loser.”

“My focus is to tell their story and to help them change their life,” Roth says. “If they change their life, the audience watches and the ratings are high.”

Bariatric surgeon Ted Khalili, founder of the Khalili Center in Beverly Hills, says that while many of his patients are fans of weight-loss reality shows, he isn’t.

“Obesity is an epidemic and these shows are trivializing it,” he says, noting that the diet and exercise plans are often extreme and unsustainable. Still, Khalili says his patients can take some eating and exercise tips from these popular programs.

Jackie Smith of Los Angeles has been a fan of “The Biggest Loser” since the beginning. The 47-year-old computer consultant says she has struggled with her weight all her life, and she’s dropped about 60 pounds in recent years through tips she’s taken from the show.

“It inspires me to do the right thing: Eat right, exercise,” she says. “It motivates me to see them overcome the challenges, because if they can do it, I’m sure I certainly can.”

Seeing oversized contestants on the show also motivates her: “Don’t get like that. That’s got to be so miserable.”

Jaci Koloars of Omaha, Neb., also loves watching “Loser.” The 32-year-old has always been active and isn’t overweight, but she enjoys seeing the contestants transform their lives and bodies.

“My mom is overweight, so it kind of speaks to me in that way,” she says. “I love seeing the health improvements they make, how much their lives change for the better, how their self-esteem increases. I would love to see that in my family.”

Besides a $50 million market of meals, DVDs and other weight-loss products, “Loser” has also inspired an online community of show fans who are trying to lose weight themselves. “Makeover” will also include a web component with free tips and recipes for viewers.

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