Tammy must see a new therapist, but things don't go the way she'd hoped. Amy wants to lose her excess skin, but she gets bad news at the plastic surgeon's office. Chris faces the scale. If he's below 400 pounds, his surgery is on.

While Chris makes progress after his surgery, Tammy gets discouraging news; Amy plans a unique bash for Tammy's 35th birthday; the family excitedly plan their first vacation together with all five siblings, but concerns rise about Tammy's mobility.