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.

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.