Patients are placed under the care of Houston surgeon Younan Nowzaradan (often referred to as "Dr. Now"), who first has them attempt losing weight on their own by following a strict diet, and then depending on the patient's progress may offer gastric bypass surgery or sleeve gastrectomy to further assist in weight loss.

retrospective in Season 4 that follows up on previous patients to track their weight-loss journey months or years after bariatric surgery.

Recap episodes titled "Supersized" and "Extended", which include additional facts and footage respectively, also aired during this season.

The purpose of this spin-off was to update viewers on the weight loss journeys of people featured in previous seasons.

She died on February 8, 2022, after posting messages on social media "indicative of her depression and possibly suicidal thoughts.

Megalomedia requested summary judgment, which was denied via the judge not ruling on its motion within the time required under Texas law.