You seem to have overlooked the exploitative part.
If these were charities, helping people manage health issues with no cameras, that would be great - but that’s not what these are.
Someone is making money off the plight of these people.
It wouldn’t be very engaging if it were “watch healthy normal Jane wash the dishes”, would it.
Additionally, producers put significant effort into fomenting drama. Just dirty tricks like long bus rides in the early hours followed by 3 hours of standing around waiting for something with no breakfast - hoping that some poor contestant will crack and say something snippy for the camera.