1. Carlton & Shantel

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.

2. Thederick and Lindsey

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.

3. Paul and Carrie

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.

4. Mike and Chrystal

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.

5. Isaac & Irene

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.