In the 4th year of his weight loss journey, Sean struggles to get past the loss of his mother and live on his own. Dr. Now intervenes to control his eating for a time, but if Sean can't learn to control himself, he will face dire consequences.

As Steven heals from his weight loss surgery his brother Justin finally decides to come to Texas to get the same procedure but his feelings towards Steven immediately begin to sabotage his hopes of surgery.

A year since her weight loss journey began, Janine is still in the 500 and mostly immobile, and now, Dr. Nowzaradan is running out of options to treat her if she can't find a way to control her eating habit and start walking again.

Lee's anger issues continue to jeopardize his relationship with Rena and threaten to derail both of their weight loss journeys; a major life event sends Sarah into depression, and she must pull herself out of it if she wants to keep losing weight.

Liz has gone from being bedbound with lymphedemas on both legs, to standing and walking, but old fears are about to threaten her progress. And if Jenn and Marissa can't get along as mother and daughter to lose weight, they'll have to proceed apart.

For Milla Clark, after 3 years & 5 surgeries, success would mean beating the odds, and becoming one of Dr. Nowzaradan's most impressive weight-loss patients ever. Failure would mean slipping back to the bedbound life she swore she'd never return to.

Pauline's self-destructive behavior continues to be a problem. Chad strives to be a better father and husband as he continues his journey. June's progress stalls when frequent travel and wedding plans cause her to slip back into bad habits.

Tamy faces a tough choice when her husband wants her back but only if she moves away from Houston and Dr. Now's program. Karina's weight loss begins to slow, but she finds happiness dating a guy Dr. Now is surprised to see in his clinic again.