Shantel's brother Carlton lives downstairs but she hardly ever sees him because at 600 lbs each, neither can do the stairs safely; to break free from a death spiral of codependent eating they need Dr. Now's help to reforge their sibling relationship.

At 600 pounds, Ashley has to move home so her mom can help her care for herself and her newborn daughter; Ashley must overcome a lifetime's worth of unfortunate circumstances and get Dr. Now's help in Houston.