My 600-Lb. Life: Where Are They Now? - Season 4

Steven Assanti's dysfunction escalates, pushing his relationship with Dr. Nowzaradan to the brink, and a risky decision is made to save Steven's life, while brother Justin takes the leap to go to Houston to finally accept help.

At 400lbs Bettie Jo achieves a dream - she's pregnant. But the pregnancy is soon in jeopardy. Will she deliver baby without complications? Susan lost 400lbs and she's in a relationship. When weight loss stalls, can she turn things around again?

11 years later, Melissa has lost 500lbs and saw her weight drop to 137lbs. Now facing marital problems, three pregnancies, and life as a single mom, Melissa is struggling with a 150lb weight gain. Melissa is at a crossroads; can she find her way?

After successful sleeve gastrectomy procedures, the Dreier twins collectively lost more than 400 lbs. and are working toward skin surgeries when a major life event disrupts their world and threatens the security they thought they had.

Erica must return to California to continue her weight loss journey but fears past emotional trauma will derail her progress.

Ashley lost over 200 lbs. in Houston, but can she regain independence & continue to lose back in California with her enabling family? No longer a shut-in, Diana has embraced her new life and shed 300 lbs., but will knee damage threaten her progress?

Kirsten must become independent to get the full gastric bypass surgery she feels she needs. Michael struggles to lose and still battles anger issues while his wife, Roni, wants her own surgery. Will they both succeed or falter under the stress?

Back on Dr. Nowzaradan's program, James is suspected of cheating as he continues to gain weight and suffers a series of life-threatening illnesses. Cynthia continues to lose weight but seems satisfied to do so at her own pace.

Losing over 200 pounds, Doug is now an active part of his family's lives and inspires a healthier lifestyle for them all. However, Doug's eating disorder and trouble finding his own identity threaten to derail his progress.

Ashley has hit an emotional wall and is desperate for skin surgery but the problem is that she's not losing any weight. After being evicted, Nicole is forced to move back to Ohio which could impact her weight loss journey.

Brittani has lost over 400 lbs. in two years. As part of her next chapter, will she and Bill start to plan to expand their family? Lupe has struggled since surgery. Having left her husband, will she finally start to make permanent changes she needs?

Sean must overcome recent tragedy's in his life before he loses all the progress he's made over the last two years. Dottie struggles to stay on track while maintaining her family life and dealing with new pains in her body.

Charity's daughter is becoming dangerously obese; devastated by the death of her husband Elroy, Milla must find a way to finally qualify for gastric bypass; check-in with individuals who have undergone skin removal surgery.