In the fourth 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 Sean's eating for a time.

A college graduate with a once-promising career, Justin has eaten his life away to the point of never leaving the house for anything but food; only the help of Dr. Now's weight-loss program can restore his hopes of living a happy, productive life.

Weighing over 600 lbs. each, Vianey and Allen are locked in a codependent relationship based on a shared love of food. As they head to Houston, they will soon find out if their relationship can handle the strain of growing healthy together.

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 toward Steven immediately begin to sabotage his hopes of surgery.

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

Kelly is on the verge of immobility when she decided to make the trip to Houston to visit Dr. Now; Her journey gets off to a painful start when a long travel day grows longer as Kelly gets stuck in a cab on her way from the clinic to the hospital.

Cillas' food addiction is getting in the way of his ability to be there for his fiancée, Jessica, and her three daughters; if he doesn't lose weight soon, he knows he'll lose either his girls or his life.

Brandon is a talented musician with a beautiful voice and a run-away weight problem; he wants to lose weight and embark on a career; he also wants to take the next step with his girlfriend, Taylor, whom he risks losing if he can't make a change.

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

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

At over 700 pounds, Brianne undertakes a weight-loss journey to save her own life; she faces an unexpected challenge to her fragile progress when her husband suffers a heart attack on a birthday she will never forget.

A mother of 4, bed-bound for 2 years, Lashanta relies on her kids to keep her cleaned and fed. Her last chance to break the cycle of food addiction that's killing her is to join Dr. Now's program, but it will take a village just to get her out the door.

Despite moving to Houston with the solid support of her boyfriend, Aaron, and her cousin, Jasmine, Tiffany finds it difficult to break the cycle of depressed eating when her two roommates don't join her diet and leave the house every day for work.

Jeanne lives in an unhygienic household with her mother and schizophrenic father; at well over 600 pounds, Jeanne might never get weight-loss surgery as she runs into several obstacles, especially after an unexpected death in her family.

When Annjeanette was nine, a campaign was established to send her to fat camp; she hated that her weight had become a source of public shame and she has struggled to overcome her food addiction; now, she must change her habits to save her life.

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

Since the death of his mother, Aaron lives at home to care for his aging father, but due to his food addiction, Aaron has to heavily rely on his father for help instead; Aaron must learn to care for himself to avoid eating himself to death.

Robin and her brother Chris are both obese and already lost a sibling to obesity; they plan to visit Dr. Now together when Chris suffers a stroke and can't go; Chris' son Garrett, already 600 pounds at age 20, is game to join the journey.

Maja moves to Houston to undertake a difficult weight-loss journey with the support of her boyfriend, Christian; when Christian decides he's had enough and leaves Maja high and dry, she discovers that the only person she can count on is herself.

At over 600 pounds, Angie is trying to get to Houston to see Dr. Nowzaradan, in hope of getting weight loss surgery to save her life; family conflict and disagreements may stop her from being able to do what she needs before she even gets the chance.

Octavia has been bedbound for nearly a year when she decides to make the trip to Houston to get help from Dr. Now, but when it turns out that her best friend is also her worst enabler, Octavia will have to choose between old habits and a new life.

Holly already has one failed weight loss surgery, so to succeed this time, she must do more than change her eating habits, she must address the childhood issues that continue to plague her.

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.

Lacey ballooned up over 600 lbs on pizza and ice cream and knows Dr. Now is her best hope for success; she must now rally her divorced parents around her for support and find a way to modulate her moods that won't include binge-eating.

Born as "Matthew," Destinee never felt like she fit in; now, having come out as a 600-pound transgender woman, she likes her curves, but she will need to say goodbye to them if she wants to be approved to transition completely.