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.

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.

For Milla Clark, after three years and five surgeries, success would mean beating the odds and becoming one of Dr. Nowzaradan's most impressive weight-loss patients, but failure would mean slipping back to the bedbound life.

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.

Erica's success on her weight-loss journey is derailed by heartbreak; Benji must reach his goal weight without the support of his brother.

Alicia's relationship with her boyfriend, Tim, comes under the microscope; Pauline must beg her way back onto the program after quitting.

Dottie faces an unexpected challenge to her weight-loss when her husband's drinking problem becomes intolerable for her and her son; Cynthia starts to wonder if being there for her kids at her current weight is more important than losing more.

In order to keep pace with her daughter Charly's impressive weight loss, Charity must do something she's never done and find a way to go it alone.

Weighing more than a ton, siblings Roshanda, Brandie and Clarence set out to lose weight as a family, but the all-for-one approach may be hurting more than it helps when each of them shows signs of heading in the wrong direction after surgery.

If Steve Sr. thought getting weight-loss surgery for his sons would help bring them together, the third year of the weight-loss journey proves him wrong; Justin returns to Rhode Island with every intention of never speaking to Steven again.