Obesity is not only a worldwide epidemic, it is also big, big business. For example, NBC’s TV hit, “The Biggest Loser,” which features overweight to morbidly obese people struggling to shed as many pounds as possible in a race-like contest, has become an enormous success in many countries around the world.

According to the show’s producers, participants are challenged to the breaking point in a rigorous regimen of supervised dieting and exercise and are tested by many real life temptations as they compete for the grand prize of $250,000. NBC also offers “top-selling fitness DVDs, diet books, club memberships, etc. In terms of dollars and cents, there are certainly no losers here.

From a professional perspective, not surprisingly, I’m highly skeptical of the validity of any incentive-driven, tough-love, boot camp-style weight loss or fitness programs that are so much the hype right now. And I don’t merely question the benefits for the actual participants, but also for the viewers who take their cues for their own lifestyle choices from shows like these.

No professional health and lifestyle counselor who is worth his or her money believes in quick fixes. Weight loss, especially on a large scale (no pun intended), cannot and should not be tried in a hurry. It may make for great drama to watch people being transformed from couch potatoes to sexy hardbodies. It may be fun to see contestants struggle and sweat, and one may even feel inspired by their efforts. But shedding pounds can only be part of the story if the changes should last.

What matters more are the underlying, much less visible changes that need to take place. These involve many more aspects of a person’s life than the reduction of body weight. All the diets and fitness regimens in the world will not work if the people who are doing them are not fully invested in meeting their health needs. People who value their health and want to live their lives accordingly should have no need for monetary rewards or other incentives to keep them motivated.

The permanent adoption of a healthy lifestyle is first and foremost a matter of choice, a change of one’s mindset, if you will. It takes a complete and integrated approach that reaches far beyond a quick, and in all likelihood temporary do-over of outer appearances. As such, it affects the entire person from the inside out.

The majority of patients who come to me for help with weight issue expect me to hand them a list of dos and don’ts to be followed to the letter. When I say that I don’t believe in the prescription of rigorous regimens but rather let them find out for themselves which approach works best for them, they seem greatly surprised. However, once they become more comfortable with the idea of taking responsibility and ownership for their own well-being, they often experience a deep sense of liberation or – as Oprah would say – empowerment. I have witnessed it over and over again with my patients: When they lose control over their health, it affects every aspect of their lives – and, visa versa, when they regain their footing healthwise, they are ready again to take on the world. But the most important part in their recovery process is that they own it every step of the way. Only then, the changes will last.

Significant lifestyle changes can have equally significant effects on a person’s identity. Coming back to the “Biggest Loser” show, I can only imagine what it means for the participants trying to cut their body weight in half in front of a worldwide audience that demands that they perform or find themselves booted off the stage. Their entire lives become a public spectacle and they themselves become actors in it. How can they ever own that, even if they succeed?

In the day and age of reality TV shows, Face Book and Twitter, not much privacy is left nor does it seem in high demand. But the public display of our lives should not result in disrespect for others, especially not where they are at their most vulnerable.

Timi Gustafson, R.D. is a clinical dietitian and author of “The Healthy Diner – How to Eat Right and Still Have Fun.” Her book is available in bookstores, at Amazon and online at www.thehealthydiner.com – To receive her free monthly newsletter by e-mail, visit her blog at timigustafson.com