If Steve Sr. thought getting weight-loss surgery for both of his sons would help bring them together, the 3rd year of their weight-loss journey will prove him wrong, as Justin returns to Rhode Island with every intention of never speaking to Steven again.

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.

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

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 Sean's eating for a time, but if Sean can't learn to control himself, he will face the direst of consequences.

Liz has gone from being bedbound with lymphedemas on both legs, to standing and walking, but old fears are about to threaten her progress. And 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 3 years and 5 surgeries, success would mean beating the odds, and becoming one of Dr. Nowzaradan's most impressive weight-loss patients ever, but failure would mean slipping back to the bedbound life she swore she'd never return to.

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.