If you secretly watch My 600lb Life, you're not alone. Every episode boasts over one million viewers on TLC, which means there's definitely people tuning in to watch people change their lives.

Every episode follows the same formula, as people who are morbidly obese try and take back their life. Most of the time they are immobile, bedridden, and unable to control their eating. With the help of Dr. Nowzaradan, these people undergo weight loss surgery and a strict diet regimen to get their lives back on track.

While the show is fairly open about the struggles of changing bad habits, there are some things that even big fans of the show may not realize.

1. It started off as a one-off

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Jonathan Nowzaradan, the son of the acclaimed weight loss doctor, got it all started when he documented the struggles of Renee Williams, who weight 841lbs when she approached Dr. Now. Williams had been denied surgery from other doctors, as the risks of operating on someone so heavy were to large.

Dr. Now agreed to operate, and his son put all the footage together for a TV special called Half Ton Mum.

"I want to be able to care for my daughters and see them graduate high school," Williams said on the program.

She received the surgery, but sadly passed away 12 days after surgery due to cardiac arrest. Her program sparked other shows about extreme weight loss, such as Half Ton Teen. Eventually, when they realized people were willing to watch shows about overweight people, TLC started up the show My 600lb Life.

2. It's not always a happy ending

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When the episodes first start, often times the spouses of the patients are seen helping them bathe, eat, and do basic chores. To stick around when someone is that ill, it seems like a testament to true love. However, many of the participants actually end up divorced after they lose weight.

Christina Phillips shed about 500lbs thanks to her new lifestyle, but her husband couldn't handle it. Zack began to resent Christina's independence, and finally she realized her husband only wanted to enable her, so they two split up.

Zsalynn Whitworth was also married when she started her journey, meeting her husband on a website called "Shopping For A Fat Girl." He didn't approve of her weight loss, and after her gastric bypass surgery he took her to a fast food restaurant. They have since gotten divorced.

3. One patient was temporarily paralyzed

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Susan Farmer, who lost 100lbs in a few months prior to her surgery, was dedicated to making sure she lived a healthier life. However, after the surgery she found herself unable to walk. At first doctors thought it was her unwillingness to help herself, but they soon realized she was temporarily paralyzed. Doctors feared that the paralysis would be permanent, but Susan was wasn't giving up.

"The surgery was my second chance at life, and I'm not going to let a setback like this take that from me," she said. "I'm going to fight. I'm going to do everything I possibly can to get better."

It took months, but Susan completed agonizing therapy and is back on her feet. She's lost over 400lbs.

4. Some patients earn money in an interesting way

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I know that when I watch the show, I wonder how these people can afford their homes and lifestyles. Sure, there's disability money, but it's almost impossible to fuel their intense diets and medical costs on that money alone. Some work as telemarketers, while others choose to sell their bodies.

At least two, if not more, of the patients on My 600lb Life, have sold photos of themselves on fetish sites like SuperSizedBombshells.com. Pauline Potter sold her photos to the site and still continues to do so despite her weight loss.

Zsalynn Whitworth was also found to be selling fetish photos to these types of sites, but she only did so in order to raise money for her surgery. Her depression due to her weight became too much to bear, so she did whatever she had to in order to achieve her goals.

5. You make more money if you embarrass yourself

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While the exact amount of money the patients receive for being on the show remains to be seen, we do know that they get more money if they subject themselves to humiliating shower scenes.

Many of these patients are unable to bathe themselves, and some are even too large to fit in the shower. I remember one girl, Nicole, who had to literally be hosed down on the back porch. TLC shows these scenes unedited, except for blurring out private parts. Though you could argue that it really shows how bad their lives are with the excess weight, a lot of fans find it a form of bullying.

But here's the thing, those shower scenes actually make the patients more money. One former patient, Amber, confirmed this on Reddit. Other patients have spoken out about the humiliation.

"Oh my goodness, I was definitely embarrassed," Nicole said about her scene. "I knew I needed help and my main focus was to do it for my children. When they came to my house, they were like, 'OK, we have to do a shower scene and do real-life stuff for real and for you to be a part of this process.' And I sat and thought about it for the longest time and it was either me not let them do that and not get the help and possibly not be around for another year or just let it happen and get the help from the doctor."

6. Some patients don't take it seriously

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You would think that if you were ill enough to appear on a show called My 600lb Life, you would at least be dedicated to the process. This isn't always the case. One patient, Penny, is proof of that.

She was manipulative, uncooperative, and unwilling to change, yet she still underwent the surgery which is fairly life-threatening. After the surgery, Penny wasn't losing weight because she was not committed to the whole process. Dr. Now said that if her delusional behavior didn't stop, she'd be stuck like this for life.

During a "Where Are They Now" episode of the show, Penny refused to step on the scale. According to her, "weight doesn't matter."

7. Dr. Now has been sued twice

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Dr. Now and Houston Obesity Surgery and Best Care Clinic, INC were sued in September of 2017 by a patient who had undergone laparoscopic surgery to remove her gastric banding and port. She also had a hiatal hernia repaired. According to the lawsuit, Dr. Now and his team left "foreign bodies" inside the patient. The case is currently ongoing.

Michelle Park, another patient of Dr. Now, sued the surgeon in 2012 for an eerily similar issue. Park and her lawyers claimed that Dr. Now had left a 6.69 inch piece of tubing inside her body after gastric sleeve surgery. According to Park, the tubing was not found until 22 months after the procedure.

This case was dismissed in 2013, and there were rumblings that it was settled in a top-secret mediation setting. Dr. Now himself said it was pretty straightforward.

"The lawsuit against me was dismissed because I was not the one who left the tube," he told RadarOnline.

8. Not all patients are for the process

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Even though their lives have been drastically changed, not every patient from My 600lb Life thinks the show is helpful. According to Cynthia Wells and Penny Saeger, the only helpful part of the show is the surgery, and after that the patients are on their own.

"[Dr. Now] only seen [sic] me on filming and did the surgery. I was handled entirely by an off-screen doctor and treated by him, and I left them and Texas over two years ago," Saeger said. She still lost weight, though, despite leaving it all behind. Saeger dropped 156lbs over the next year through healthy diet changes.

It's impossible to ignore the good that My 600lb Life does for these patients, but sometimes we don't know the full story behind it all.

Do you watch this show?