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Siblings Carlton and Shantel have always been close, but with their eating habits enabling each other, they need to make a change; Shantel is sad to grow apart from her little brother, but it might be for the best.

Thederick has lost enough weight to get the giant lymphedema mass removed from his leg, in one of Dr. Now's biggest removals ever. Will he even bother to pursue weight loss surgery after that? Lindsey loses more than weight when she loses her husband to another woman.

Paul made a promise to his girlfriend that he intends to keep; to ask her to marry him within a year's time. Now he just has to lose about 300 pounds. Carrie needs surgery badly, but she prefers not to change her eating habits.

Mike has an unusually tough decision to make, when moving to Houston for weight loss surgery might mean forfeiting custody of his kids. Chrystal finally gets her surgery and makes a big leap towards being the mom her kids deserve.

Isaac has been close to getting surgery many times, but putting family first keeps him from getting the help he needs. Irene's slow-and-steady approach finally pays off.

Michael has a new lease on life post-surgery and a return to martial is arts is just the beginning, now that he has lost upwards of 300 pounds. Lucas was doing great, when a bit of backsliding proves difficult to overcome.