I am not a reality TV person. Mostly can't stand any of them, except for American Choppers, but then I love seeing metal being bent. So it came as a surprise to me that having heard all negative about this I got sucked into an episode. There is one thing that is not emphasized on the show, but apparently these women get pretty extensive counseling along with all the other physical transformations. These women all have emotional scars that would probably never be addressed out in the real world, but here they are getting many hours of free counseling every week. I find nothing wrong with that and I only wish the producers would spend more time portraying what results they get from this time spent with psychological staff. Plastic surgery is very, very common and its portrayal on TV should come as no shock to anyone.
As for being the "bottom of the barrel" I'm thinking folk are barking up the wrong tree. Seems to me there was a show called 'Temptation Island'. Never saw it but understand the object was to steal partners or some such. Seems to me much worse than women with problems, who want to change themselves, finding free help.