Original subtitles

Every day I question whether or not

I should keep going like this.

-What's the matter? -[crying] I'm hurting!

Something in my head is telling me I have to eat the food.

I just can't stop.

My whole life revolves around food.

Make sure you put butter in the bacon.

[man] When I eat, I never wanna stop.

[woman] He eats in his sleep.

I think other people take for granted the ability to just move

and not be in pain all the time.

I have severe anxiety.

I have stabbing pain in my feet.

The lymphedema growth, it's got open sores that leak body fluid.

-I have depression issues. -Diabetes. High cholesterol.

-High blood pressure. -Ouch! [Bleep].

My body is crushing itself.

-[woman distantly] Are you okay? -No.

That's what living like this has done for me.

If you keep this up, I guarantee you neither of you

will be here five years from now.

My food addiction is killing me,

and I know it's now or never.

Can you imagine being a... Arabian horse --

strong, ready to run --

but you stuck in the body of a elephant.

You are not ready to lose weight!

Prove them wrong.

I'm so close to quitting, it's ridiculous.

Ooh.

-I tell my dad, "We got this... -Eight. Nine.

...I'm behind you no matter what."

Honestly, our intimacy has changed.

If something doesn't change, I will either be a widow

or I'll be divorced.

Oh, [bleep].

-[sobbing] -Well, I'm sorry.

I'm scared it's already too late for me.

The situation could still become critical at any moment.

Every time I go to bed, I wonder if this is the time

I don't wake up.

[sobbing]

I'm trying to tell y'all I need help. I want it.

If I don't change, I'm gonna die.

[Nathan] I'm at a point now where it's painful to do anything

and it gets worse everyday

because now I have this large sore on the back of my leg.

[woman 1] Somewhere in me is this little glimmer of hope.

I just want to be a normal person.

You can't do it and then I just get mad.

[woman 2] If I don't make a change now, I'm scared it's going to be too late.

-[groaning] It hurts. -Stand up, you're all right.

[woman 3] I refuse to stop fighting.

I have to do this for my children.

Does she respect you?

[Amber] No. Probably not.

I just want her to be proud of me.

[sighs]

[Nathan] The mornings are the worst part of my day.

And I hate waking up

because of how hard and painful it is being in this body now.

I can't really lay down anymore, you know.

I can't breathe if I do because my weight pushes the air out of my body.

So, I started sleeping in my chair, but I hate that

because it means that I can't sleep by my wife Amber anymore.

She's usually gone by the time I get up.

She's a school teacher and so am I.

I teach theater, but I've been on medical leave for a while now,

because of how hard it is for me to get around at the size I'm at.

I'm at a point now where it's painful to do anything

I think other people take for granted the ability to just move, you know.

And not be in pain all the time.

Like, I'm constantly in pain even sitting.

Go use the restroom.

But the dogs, if I don't let them out,

then they'll have accidents around the house.

I won't be able to clean it up.

So I push myself to let them do what they need.

Come on, house. Let's go.

But after that, I have to get to where I can rest as soon as possible.

And I already want to go back to bed.

But in the morning, I have to get clean.

[shower running]

Because the growth that's in between my legs,

the lymphedema growth,

it's got open sores that actually leak body fluid.

And not taking care of that could lead to infections,

and infection means I could wind up in the hospital.

So as much as I hate it because of how hard it is,

I make myself shower everyday.

It's just hard to do because of my size.

And sometimes I don't get as clean as I want to.

Sometimes my wife has to help me,

but when she's gone, I try to do it on my own.

Some of the things that I do Nathan specifically asked

that it not be mentioned

because I do things

that not even a wife should have to do.

[Nathan] It just shows how bad off my body is.

That's not something that a healthy person should experience.

Knee pains and back pains and open sores.

I shouldn't have all that.

And it gets worse every day,

mainly because of the sore on my leg.

It's itchy and it's filled with puss.

So I have to keep the wound dry

so it doesn't get infected and get even worse.

Dad's going to go fix him some food. He's hungry.

And finally, now that I'm clean and dressed and dry,

it's time for breakfast.

There isn't a moment when I'm not craving something to eat.

No matter what I'm facing, food will make it better.

Food is my relief and my comfort,

and it's what I constantly want.

Food is the only thing in the world that doesn't talk back

unless it gives you acid reflux.

It's just going to make you feel better.

And when I'm eating, it's euphoric.

It's like this feeling of relief from whatever negative emotion

I have going on at that time.

And so, even though a meal like this will make me really full,

I'll keep eating and eating.

Because that craving never goes away,

and it's always been there for me.

Eating has always been a big part of my life,

starting when I was really young.

I think part of that is because my dad worked for a food company.

So we constantly had junk food around us.

You know, I'm the youngest of three siblings.

I have an older sister and an older brother,

and all of us, including our parents, just ate all day long.

Food, it was almost like a headache pill would be for a headache

because it made me happy.

But the downside of that

obviously that led to me putting on weight.

I didn't realize it at first,

but in junior high, when I was 13,

that's when the bullying really started because of my weight.

Because I got up to over 250 pounds by then.

I was probably already in like a 1X, 2X.

And I can remember I tried out for basketball

because I liked watching basketball.

And I thought, maybe I would be good at it.

They made us try out in front of the whole school in the morning

because what they did was they had the students

assemble in the gym

before they went to their first period.

And people were laughing and pointing,

and the coach had to stop tryouts.

And he yelled at them, saying, "At least he's down here trying." You know.

Being 15 and around 350,

I didn't really try to make friends.

I kept to myself and after school, I'd just go home and eat.

When you get upset, you reach for that ice cream, you know.

And I can finish ice cream like nobody's business.

But things did get a little better

toward the end of high school.

That's when I fell in love with theater.

It was theater that made me feel like

I could be who I wanted to be.

I still to this day think

that my theater teacher in the high school level

was probably one of the ones that helped get me through.

It was around the same time that I found out my mom was diagnosed with cancer.

And ironically at that time, I was playing a cancer patient

while my mom was going through the cancer treatment.

So, it allowed me to really deal with it in a safe place.

I chose a college based on theater.

But I was still eating a lot and gaining.

And by the time I graduated, I was around 450 pounds.

But immediately after I graduated,

I got a job at a high school in Longview,

and that's where I met my wife, Amber.

Come on, guys. Get back. Get back, get back.

-Hey. -Hey.

-Thank you for picking up the food. -Welcome.

[Nathan] So how was your day?

[Amber] It was crazy.

-[Nathan] Oh, really? -Yeah.

[Amber] From the first time I saw Nathan,

I could see what made him special.

He's a great person.

He is an amazing theater director,

he is an amazing teacher.

And having similar backgrounds with food

was something I saw as a positive back then.

And that was one of the things that I was attracted to

was the idea that

he would be a partner for me

to keep focusing on my journey with.

-You want a cheese stick? -No, thank you.

[Amber] But shortly after we got married,

Nathan went to a doctor

to try and get weight loss surgery.

So, I actually got approval for surgery

because I had lost enough weight.

And I didn't have the copay

and so, they cancelled my surgery.

And I guess at that point, I was like, "Forget it.

I'm... I'm done. I'll just eat however I want to."

-You want a bite? Last bite of sweets? -Sure.

That's when all of his motivation

went by the wayside really quickly.

[Nathan] I guess I felt like I wasn't good enough.

When we'd go to eat,

I physically was getting ill from watching him eat.

He would eat his food.

He would eat an appetizer. We would have a dessert.

He would eat my leftovers and it would make me

just absolutely just disgusted.

When Nathan decided he didn't want to try

and lose weight anymore,

I told him I was disgusted with what he was doing.

And I basically told him he was an embarrassment.

[Nathan] You remember we have to get to the grocery store, right?

Mmmhmm.

[dog barking]

All right, I know you're tired,

but [sighs] can you really help me to wrap my leg?

Yeah, I guess I'll do it before I go take a shower.

[dog barks]

[Nathan] So now I'm at the point

where I'm 600 pounds,

and I have a huge lymphedema mass on my legs

that pretty much keeps me stuck in my chair all day everyday.

I wanted to be a good father to our kids

just as much as I wanted to be a good husband to Amber.

Because when we got married, she had a son, Mark,

and a daughter, Hannah, who were ten and six.

And now they are my kids too.

But my weight has become a really big problem

in my relationship with Amber,

and with our whole family.

[Hannah] I do worry about my dad's health.

I would like him to feel more confident in his body

and lose some of the weight so we can do more activities together.

I always tell him that, like, "Don't give up.

We got this. I'm behind you no matter what."

Sometimes I feel like he's not going to be okay,

but I really do believe in him.

[music playing on radio]

[Amber] I'm driving to the grocery store

because that's what me and Dad needed to do.

[Nathan] I want to be off experiencing things with my family,

but I can't because of my size.

And now I feel like grocery shopping is the only thing

that me and Amber really have left together

and it's the only thing we do together aside from eating.

And if you took eating and food out of our relationship,

we wouldn't have anything left now really.

[Nathan] They have carts. Thank God.

-[Amber] Yeah. Yeah, yeah, yeah. -Ow, ow.

For three years, Nathan's health has not allowed us

to completely do those things that we enjoy.

And our relationship is very strained

because of the amount of care that I have to give him.

And I miss being able to have,

I guess, an intimate relationship.

Not like a sexual relationship,

because Nathan and I have never.

-Hey, look. They have croissants too. -[Amber] Huh?

-[Nathan] You like croissants, don't you? -Uh-huh.

[Amber] That's not what it's about.

But just like, being able to spend

quality time with each other

where it doesn't involve care.

That's what I want that we don't have anymore.

And I'm very scared I'm going to be just like Nathan.

I would say within the next four to five years.

Because it's getting to where I'm having trouble

doing what I need for myself.

I'm over 400 pounds now.

That's what living like this has done for me.

-You want some bologna? -[Amber] No.

I have severe anxiety.

I have depression issues.

And I am always extremely exhausted.

-[cashier] You all doing all right this evening? -[Nathan] Yeah.

[Amber sighs] Yeah, yeah.

We're super tired.

-I'm going to place this right here for you. -Awesome. Thank you.

[cashier] You're very welcome. You be careful out there. Be safe.

-Can you... You need to open that since we're slow. -[cashier] Yeah, okay.

[Amber] And I just feel like Nathan's just let me down

as a husband altogether.

He has tried his best.

I don't want it to seem like he hasn't.

But it's getting to be too much.

And I'm at a point now

where everyday I question whether or not I should stay.

And I stay because I have love for Nathan.

But I just can't keep going like this.

Neither of us can.

[Nathan] I can't do much of anything on my own anymore.

And I know that frustrates Amber

and it's a lot for her.

So much so that we had to move our whole life here

to Palestine, Texas.

Because she needed help

and the only family that she could go to were her parents.

So they help out when it's too much for Amber.

And I hate it because I feel like I'm a burden

to my whole family at this point

and I'm ashamed of that.

And if it gets to be too much for Amber,

I'm scared she's going to leave me.

[Nathan] My appointment with Dr. Now is tomorrow.

So today, I'm headed to Houston.

[Jack] We're here. Hey.

[Nathan] Amber is working today,

so my in-laws came over to get me

and help me get there.

[Tracie] Are you ready?

Ready as I'm going to be.

It's only three hours there and three hours back.

But I told Amber I wanted to go down

the day before the appointment

so I can rest before we see Dr. Now.

All right, what's... What's going?

This is a bag of snacks.

Where's mine?

-It's in there, Jack. I promise you. -Okay, okay. I'm just...

Because you know I don't do jalapeno stuff.

I'm making sure you got my chips.

-I did. -You stay right there.

[Jack] Because over the years,

I've seen him get bigger and bigger.

Before he was able to move around a lot more.

And do a lot more things.

But now that he's so big, he's limited.

He can't do a lot on his own.

So we help him out when he needs us,

when Amber can't be there for him.

But we're all scared for him because of how bad it is now.

-You have your charger? -Yes, everything's in there.

-You sure? -Yes.

-Okay. -You can't use mine.

I know.

If he goes on this,

it would be benefit for both of them.

Because if he can lose the weight,

it'd make both their lives better.

-Are you excited? -Yeah, I am.

Nathan has struggled with his weight since I've known him.

Even early on, I saw how he ate

and I remember they had just moved down here.

And he got up and made breakfast one morning for himself.

He made macaroni and cheese and a can of peas for breakfast.

And I'm like going,

"Oh, that's disgusting." [laughs]

But over time, I've seen him gain more weight.

And it's getting to a breaking point for him

and I think Nathan does understand.

He is a young man with a short lifespan right now.

[Tracie] We are on the road. Yay.

On the road again.

[Nathan] I'm a little bit overwhelmed

and I'm embarrassed

because I'm starting to feel a little bit of shame.

I know I have to do this,

but it shouldn't have gotten to this point.

Isn't this where I'm at right now.

I guess I'm a little shaky

because this may be the last chance to save

what I can see as my family at this moment.

So I'm ready to make a change to my life, no matter what.

[Jack] How much is that going to be?

-[cashier] Thank you. -[Jack] Thank you.

Ooh.

[Nathan] Best chicken fingers ever.

Because I know what's at stake

to save my life and save my family.

And I'm not going to fail and let them down.

[exhales]

[Nathan] I'm tired and a little sore.

But I'm in good spirits

because I get to see Dr. Now today

and hopefully get his help.

I think, overall, I'm mostly just nervous

about hearing what he says.

So, I'm glad Tracie's going to go with me

and I have her support so I'm not doing this alone.

Because what happens today at this appointment

determines everything for me.

Mr. Prater?

[Nathan] And whatever Dr. Now has for me to do,

I'm ready to do it if it means I can get a better life for me and my family.

[Nathan grunts]

It's never fun seeing my weight on the scale,

especially knowing other people are seeing it too.

It's embarrassing.

But I know my starting point now.

So from here, my goal is to get that number going down.

[knock on door]

-Hello, how are you all doing? -I'm good. How are you?

Good.

All right, Nathan, good to meet you. Glad you're here.

-Yes, sir. -Now who's this young lady with you?

[chuckles] This is my mother-in-law, Tracie.

-Your mother-in-law? -[Tracie] Yes.

[Dr. Now] All right, good to meet you both.

-So, you come here from Palestine, Texas, huh? -[Nathan] Yes.

And you're here to see me to lose weight

because you're just over 600 pounds?

-[Nathan] Yes. -Is that the highest weight you have been?

That I know of, yes, sir.

Okay. Well, that amount of weight puts a lot of strain

on your body, especially at your height.

And it doesn't take long for your health

to start deteriorating rapidly

especially if you're not very mobile.

And how much you can walk or be active?

It hurts to... Like, when I'm at home

and if I go from the bathroom back to my living room,

I get winded.

So I can't walk very far without help.

And what makes it worse is that I have lymphedema.

-[Dr. Now] Mmmhmm. -And so there's issues

with open sores on my legs. My right leg.

And I also have a growth in the groin area.

And it just... It feels like it's getting bigger,

so it pulls at the lower back

and that's what's adding more to the out of breath right now

I think, I don't know.

Okay. So you have developed a lot of issues from your weight.

So you are at a critical point now

where you have to change your eating habit

before things get worse for you.

So how committed are you to make the changes?

I... I'm gonna have to be 100% committed.

That's... That's it.

-It's either that or-- -"I'm gonna have to be"

is a figure of speech.

[stammering] I will tell you that I am going to be 100% committed.

-So you are ready to make the changes? -[Nathan] Yes, sir.

Okay. That's what we wanna hear from you.

So the changes that we're gonna do,

I don't want any excuses that,

you know, "The weather was not good,

I was depressed,

-and food was there, I had to eat it." -[inaudible]

Those excuses, I don't wanna hear them when you come back.

-Right. -[Dr. Now] Okay.

And your wife, does she struggle with her weight too?

Yes. Um, she is overweight as well.

So why isn't she here with you today?

She had to work.

Okay. So I'll give you an extra copy of the instructions

for you to take to her so she can understand

what needs to be done to support you.

And the next time you come back,

see if she will come with you.

Okay, Doctor.

Okay. I'm gonna give you some written instruction

that I want you to read every day

and I'm gonna give you some exercises.

I want you to start doing those exercises twice a day. Okay?

-Okay. -Well, any questions?

No, sir.

All right. So let me get all the stuff that you need to do

-and then we go from there. -Yes, sir.

-All right. I'll be back. -[Tracie] Okay. Thank you.

[Dr. Now] Nathan seems motivated.

Hopefully, we see that translate into action with him

to where he makes the changes he needs when he goes home.

But ultimately, no matter the situation,

this is all gonna be up to Nathan

to make the changes he needs to get healthy.

All right, Nathan. Here's your homework.

If Nathan wants to move ahead,

he's gonna have to prove to me that he's committed.

So he either does this and hits his goal

to show me what I need to see from him

or weight loss surgery won't be an option.

Because it will ultimately fail

if he isn't willing to do at least his part.

All right, Nathan. This is something you have to do

if you want to get your life back

before you run out of time.

So you have a lot of changes to make.

-Yes, sir. -All right.

You think you can do that?

Yes, I... I do.

[Dr. Now] All right. Super. So I see you in two months.

Lose 60 pounds by then

and work to get your stamina up.

In the meantime, if you have any issues, give me a call.

-Okay. -[Dr. Now] All right.

Before you go, we're gonna run some tests

to check on some things.

And if everything looks good, you can go home. Okay?

-Yes, sir. -All right.

Nice to meet you guys.

[both] Nice meeting you.

[Nathan] That was intense but it was good.

And I'm excited

because I have a plan to fix what I messed up

and finally make things right like I should.

So I'm happy about that,

and that I have this chance.

But I know it's not going to be easy.

It's gonna be a hard road ahead to do this.

But I'm ready for it.

[Dr. Now] Nathan is already developing

severe medical issues with his body

that is a direct result of his weight.

So he doesn't have any more time to waste.

He either make the significant changes he needs now

or things are gonna continue to get worse for him

until he pushes his body to a breaking point.

And my concern right now

is that he may a lot closer to that point than he realizes.

So it's very important he does this now

before he gets to that breaking point

and something happens where he doesn't make it.

[Nathan] Ready?

Oh, you better get up. Go to the door.

[grunts]

[Nathan] It's been three weeks

since my appointment with Dr. Now.

Whoa.

And since then, Amber and I have been focusing

on making all the changes I need

with the diet and exercises.

[Amber] Come here, Peanut Ann.

[Nathan] I feel like my journey is in a really good spot

because I can finally see something positive

moving forward in my life.

The most significant is the energy.

There's just some things that I'm able to do physically

that I couldn't do 20 days ago.

So I actually look forward to exercise now.

[Amber] Come on, this way. Come on, mama.

[Nathan] Walking with Amber,

she always has a good attitude.

[Amber exhales]

[Nathan] I think our relationship has changed

for the positive.

I feel like we're headed towards a better situation.

[Amber] Nathan's actually been better than I expected.

As soon as we got back to town,

with counting calories and his exercise...

[Nathan] No, stop eating everything.

[Amber] ...he jumped right in, so I was really impressed

and I would say overall he's doing great.

So I really expected him to struggle more than he has.

[Nathan] I don't even know how far we walked.

[Amber] About an eighth of a mile.

-Oh. Well, we can turn around if you need to. -No, till the stop sign.

[Amber] I'm good. I just... It hurts.

[panting]

[Nathan] I try to walk every day for, like, 20 to 30 minutes.

The changes have been pretty easy for me

because I just got to a point where I chose life.

-You made it to the store. -Yeah?

-How you feel? -I'm good.

You're not too out of breath. That's good.

Are you ready?

[exhales] Yeah.

I think so.

-All right. You first this time. -All right.

-Let's go, Big T. -Let him take the charge

and the lead.

-Me and Peanut will go towards the end. -You know he will.

-This way. Go home. -We're going home.

Let's go home.

[Nathan] The transition to eating healthier

has been a lot easier than I thought.

I try to stick to the 1,200 calories or less...

[clicking]

...not allowing myself to just eat what I want to when I want to.

Going into it, I was like,

"I'm gonna have to eat all this stuff that I don't like."

Well, when I figured out that I could stay under the 1,200

and work hard and still lose the weight,

I was like, "I'm gonna do this."

And so if I feel the urge to have ice cream,

I always make sure that it still falls

under that 1,200 calories or less.

I'm still getting my little fix

but I'm staying under the calorie count.

Remember how I would get, like,

a chicken and a burrito and two Big Reds?

[Amber] Yeah.

That has changed a lot.

Why would I do that?

-[Amber] Well... -And why would you let me?

It's not about what I would let you do.

What would you do if I went back to that?

[Amber] Well, I don't know...

to be perfectly honest

because I've already told you how I feel about things as they were.

How much bacon do you want?

Just a couple of slices.

[Nathan] How do you feel?

[Amber] I mean, I already told you, like, it's too much for me. I'm...

I'm your caregiver. I'm not your wife, so...

[bacon sizzling]

[Nathan] All right. In 2.5 miles, you're gonna exit 125A.

[Amber] Hello! I know where I'm going kind of.

[Nathan] Amber and I are in Houston

for my second appointment with Dr. Now.

I told her how important it was to me

for her to be the one that brought here.

[Nathan] It's on the corner right there.

See where that red car is?

[Amber] Voila.

[Nathan] 'Cause I want her to see the progress that I'm going to have.

So she made the time to do this with me today

and that means a lot.

And I'm feeling better than I have in years.

I made all the changes and followed all of Dr. Now's instructions.

-Nathan. -[Nathan whispers] You ready?

So whatever the scale says, I think it's going to be

something I'm at least proud of.

But my ultimate goal is to get weight loss surgery.

And that's not gonna happen if I didn't lose

all that I was supposed to lose by today.

[nurse] We're gonna weigh you.

-Just hold on one second. -Yes, ma'am.

[nurse] Let me just level it out.

Okay.

-Go ahead and step up on the scale, please. -Yes, ma'am.

[Nathan] And if I don't get weight loss surgery,

all I've lost today won't mean anything.

[Nathan] I'm back at Dr. Now's for my second appointment

to see if I made it to my weight loss goal.

And I think I have a good chance at it today.

At my last appointment, I was 607 pounds.

And Dr. Now told me to lose at least 60 pounds in two months.

So that means I need to be under 547 pounds today.

Wow. [chuckles] I'm excited.

Good for you.

I'm good. I'm good.

[knock on door]

-Hello, how are y'all doing? -[Nathan] Good. How are you?

[Dr. Now] I'm doing good.

This must be your wife, Amber.

-Yes, sir. -Well, good to meet you.

[Amber] Good to meet you.

-So, Nathan, you're down 72 pounds, huh? -Yes, sir.

So tell me what changes you made.

The biggest change that I've made

is I've really stuck to the 1,200 calories or less.

That's the ultimate bottom line for me.

Plus, I will not eat anything past six o'clock.

I just... I've made it a point to make sure that

I have dinner before 5:00, 5:30, so.

[Dr. Now] All right. That's great.

Well, I'm proud of you.

But my concern right now, seeing both of you,

is your wife has a weight problem, too.

So it's very hard for one person in a family

to eat healthy while the other person is not.

So, Amber, have you talked about getting healthy

and doing this with Nathan?

Um, I actually already had weight loss surgery when I was 16.

And so I'm really familiar with the weight loss process.

And I already kind of had

somewhat better eating habits than he did.

I've been preparing food for the last ten years

to his accommodations really.

So you're saying it's his fault he gained weight?

[Amber] Not necessarily.

Okay. Then would you consider yourself

failure of the weight loss surgery or success?

-Me? -[Dr. Now] Yeah.

I would say I was success...

I was a success until I had my children.

Because I was very successful,

I lost over 360 pounds on my first...

With my first surgery.

Well, you're like a gambler sitting at the table and saying--

[both laughing]

..."An hour ago, I had a million dollars

but then right now, I'm out of everything.

So I was a successful gambler."

That's not the reality.

Where are you at this point and what you need to do

is the issue.

Now, you may consider that a lot surgeons,

they don't do revision because that's complicated

and it's not something that your surgeon are acquainted

or willing to do,

but that's something we may be able to perform.

People in the high BMI, 90 to 95%,

have failure of their weight loss surgery in ten years.

And the reason for that being that the underlying issues

driving you to eat were never fully addressed.

And in your case, your success was only short term.

And that's a factor now,

not just in your health, but Nathan's health

Because you both influence each other negatively.

I'm frustrated and angry

because this journey was supposed to truly be about Nathan

and Nathan's health and his well-being.

And I don't want to take away from that

and I feel like that's going to happen.

And I don't want that to happen.

I was 16 when I had a procedure done

and now I'm 60 pounds heavier than I was when I started that.

There's just not words for that emotion right now.

So I think the dynamic of household will be better

if you both are working to get healthy together

so that both of you are in the same situation

with the eating habit

and able to manage it together.

So is that something you're interested in?

Yes. I think I'd like to do that.

Okay. Nathan, because you hit your goal,

since you have made good progress,

I'm gonna go ahead and approve you

-for weight loss surgery. -Yes.

-[Amber] Yay! -Oh, thank God.

[Dr. Now] Okay. All right.

So we'll schedule that for next month.

In the meantime, don't let your guard down.

Just stay on track and keep losing weight.

-Okay. -[Dr. Now] Okay?

But we need to do some more testing on you

to make sure that the surgery is gonna be

a safe option for you

and if everything looks good and you still are trying,

then we will proceed with weight loss surgery here very soon.

-Okay? -Okay.

All right. So let's set you for some testing

and go from there.

But right now, let's get your weight, Amber,

to see where you're at

and I'll get some instruction to go over with you.

Yes, sir.

Nathan is doing very well

and I'm proud of the progress he's made

over the last two months.

So I'm confident he's ready for weight loss surgery.

But my concern right now is Amber and her health

and how that's gonna affect both of them going forward.

Are you gonna look into the revisions?

I mean, I'll look into it again.

But I have before, I'll do it again.

Is that something you want?

I hadn't really thought about it much.

Okay, Amber. I'm gonna start a chart on you, okay?

And we check your weight and all that.

-That's if you want to. -Yeah.

[Dr. Now] Okay.

That's what you want, right?

-[Amber] Yes, sir. -Okay.

So let's do that now.

Amber seems to blame Nathan

for most of their poor eating habits

and has excuses for why she got them

to the weight she is.

Okay, you can step up on the scale.

Do I need to turn around backwards?

Your weight is 502.

But the reality is that at her size,

she's eating because she wants to eat

and so she shares some of the blame

for their dynamic as well.

And if she doesn't take responsibility for her part

in their unhealthy dynamic

and how her behavior influenced Nathan negatively

just as much as his does to her.

Then it will be unlikely either of them

will be successful making any progress

that will last the long term.

Hopefully, she considers the option

to change her unhealthy habits

and ultimately, get a revision

to her previous weight loss surgery that she has failed.

All right.

Well, Amber, you are just over 500 pounds. 502.

-Yes, sir. -All right.

So your weight is less than Nathan

but at your height,

your BMI is 20 points higher than Nathan.

So your weight is putting more strain on your body

than his weight is on him.

So what we need to do is also work with you

to get you to lose weight.

So I want you to read these every night.

-Yes, sir. -And start working on that.

So both of you have the same instruction.

And, Nathan, I want you to stick with what you are doing.

And Amber, I want you to lose 50 pounds

over the next two months.

-Yes, sir. -Okay?

But first step is to change your eating habit.

So make sure you only eat two or three times a day,

no snacking,

and your daily limit is 1,200 calories. No more.

-Okay? -Yes, sir.

All right, Nathan, I'll see you in the hospital

-and we go from there, okay? -Yes, sir.

And if either of you need anything, give me a call.

-Yes, sir. -All right.

-I'll see you later. -All right. See you later.

Thank you, Dr. Now.

[Nathan] I'm extremely excited that I got approved

for weight loss surgery

because that's something I've wanted

for a really long time.

The fact that she responded to Dr. Now

and told him she'd consider doing his program

has me excited.

Because one of my big fears

is how our relationship became about food

and what losing the only thing we have to bond over

could mean for us.

So if we have doing this to bond over now,

that'd be incredible.

And if she could get another weight loss surgery,

I think it'd be amazing

because there's so much we want to do

that we haven't been able to do because of our weight.

Then we can build a new life we've dreamed of together.

[Nathan] After the last appointment with Dr. Now,

Amber and I came back home to Palestine.

And after a day or two, Amber was able

to think through Dr. Now's offer

to do his program and try to get a revision to her weight loss surgery.

[Amber] You know, when Dr. Now approached me

when Nathan was there to be seen,

I was angry. I was really angry,

And I was hurt, because I felt blindsided.

But once I had time to process,

I was overjoyed.

Because just knowing that Dr. Now is willing to help me

just makes me blessed and makes me excited now.

[Nathan] And so, I'm happy about that.

And I'm just really happy that we're doing this together now.

[Amber] What are you gonna get, dude?

-I'm thinking the lunch Swiss chicken, maybe? -Okay.

Um, but what do I want today?

Oh, I love their potato soup.

Would you like any appetizers today?

Montreal steak? Fries?

-No. -[chuckles]

[Amber] It's also been a big motivation for me

to see how Nathan's been doing.

But I still do worry

because Nathan has the tendencies

to go back to his old habits.

Broccoli and mac and cheese, and a broccoli... [inaudible]

[Amber] So there's still the possibility of failure.

But I'm trying to keep...

-as optimistic as possible. -Thank you.

So what do you think?

'Cause this is our first time eating out

since you've had your... Been on your little journey.

-Like, out in public. -Mmmhmm.

How do you think you're gonna do?

'Cause you got a smaller meal,

you think you're gonna be hungry...

afterwards? You think...

-Probably shouldn't think about it. [chuckles] I mean... -I guess so.

It's one of those things that you just can't plan.

I was nervous going to the restaurant

because that restaurant in particular,

I normally would get all this stuff

that is insanely unhealthy.

But I went in there with the idea of

" have got to make sure that I start making good choices."

Otherwise, what was the point of me

going through the whole journey in the first place?

I am definitely ready for surgery.

I pray that it happens next week.

[woman speaking indistinctly over PA system]

Will you help me put these on? I never get these on right.

I can do that.

They're gray this time.

We're here at the hospital for my weight loss surgery.

[Amber] They were bigger.

[Nathan] I'm excited to finally get something I've needed for years.

[Amber speaking indistinctly]

[knock on door]

-Good morning. -[both] Good morning.

-How are y'all doing? -[both] Good.

All right. Nathan, you're ready for your big day today?

-I am. -All right.

So far, you have done good job on losing weight.

And that make, uh, surgery and risks much less.

So you're doing good.

-And you're ready for this. -Thank you.

All right. We're gonna get you started, okay?

-Yes, sir. -All right.

We'll see you in a few minutes.

[nurse] We'll lift your head and arms, is that... Good.

[Nathan] I don't take for granted what today means.

And how important this is for me.

-[nurse speaking indistinctly] -[air kisses] Love you.

Because I'm starting a new life today,

so this is kind of like a birth in a weird way.

Because it's the official start of the new me.

So I'm excited about that and the fresh start that it's gonna give me.

Because I'm leaving the old me behind.

And when I wake up, I'm going to be a new person ready for a new life.

And I can't wait for that.

[Dr. Now] Today, we're gonna attempt to do a gastric sleeve on Nathan.

So far, he's done a great job,

and he's continued to lose weight

and lost another 14 pounds this past month.

He's down to 521,

so he's moderated and he's working hard,

then started doing what he needs.

So I think he's ready for his weight loss surgery,

All right. Give me a knife.

[surgeon] Room lights off, please.

[Dr. Now] But he's still around 500 pounds,

and he's not very tall,

So this still is gonna be high-risk surgery.

Okay. Let's transition now. Bring the robot.

Because all that weight

is putting a significant amount of strain on his body,

to where any number of small things

can push his body to the limit.

So we have to be careful today

to make sure that doesn't happen.

The greatest factor with that is how long he has to be under anesthesia.

Because the longer he is under,

the more strain there will be on his body.

But I'm hoping that using a robot

will help us safely go faster,

so the surgery would not be a long operation.

Then, hopefully, we'll be able to complete it without issue.

And give Nathan an important tool

that will help him lose more weight

because what this surgery does is reduce the stomach by 90%,

leaving a small narrow tube that looks similar to a sleeve.

So the patient's food intake is physically limited

and the patient is less hungry,

So this operation will give them an opportunity

to lose even more weight.

[Amber] I am waiting to hear that

Nathan is recovering so I can see him.

I'm not worried,

because this surgery is something that is done so often.

But sometimes things, you know, happen

when you're in surgery and under anesthesia.

So I'm looking forward to...

Just knowing that he's come through everything successfully.

So I'm just trying not to get too overanxious.

[Dr. Now speaking]

Okay. All finished.

Nathan's surgery went very well.

We were able to complete his sleeve gastrectomy,

and, uh, he's doing very well.

Nathan had a very long stomach and big stomach.

We were able to remove 80-85% of his stomach.

And this is Nathan's stomach we took out. It's a...

very long stomach.

And it can hold a lot of food.

So he's gonna be able to lose weight much easier after surgery,

because he's gonna be able to eat small amount,

get full real quick and not be as hungry.

And operation's gonna give Nathan

a better chance to control his eating habit

and lose more weight

and get closer to his ideal body weight.

So having the stomach reduce capacity by this amount

will help him to get full faster.

For the next month, Nathan will need to stay

on liquid diet until he fully heals.

But, during that first month,

he's gonna be able to lose at least 40 pounds.

Then, once he goes back on solids,

he should be able to lose at least 20 pounds each month

until he gets close to his target weight.

So this surgery will help keep Nathan on track

while we work to address the underlying issues

and the dynamic behind all this unhealthy eating.

But I think he's gonna do very well.

I'm a little bit more concerned about Amber,

because she already had the weight loss surgery.

So she already has had a tool to help her,

and it failed because she ultimately

didn't stick to doing what she needed.

But hopefully, at next month's appointment,

we will see enough progress from her

to show me she's trying to turn things around

so we can move ahead with her weight loss surgery

and start working on addressing the issues

driving both of them to eat,

so that they both can have a chance

to be successful in the long term.

But we have a long way to go, and a lot of work to do

with both of them to get them to that point.

[Amber] Okay, so...

Breakfast...

An egg, please. You're gonna scramble?

No, I thought I'd just, you know,

bounce it off the floor and see if it works.

You could... [stutters]

-Like, do it-- -Don't... Don't ask me

to try fry it. Don't.

I've been home from surgery for a little over two weeks,

and I've been doing okay.

It's just been a bit of an adjustment

with how little I can eat.

But overall, I feel a lot better.

I was put on a liquid diet after surgery for a week.

And that was tough.

And then he put me on what is called the Stage 2,

which is mainly liquids,

but I could add stuff like vegetables juice,

or skimmed milk, and maybe some yogurt.

And I'm supposed to stay on that for another week.

But after two weeks of not having anything solid,

I couldn't take it.

And I'm eating a lot of mashed potatoes lately,

and I know there's not protein in mashed potatoes,

but it's one of the things that I could tolerate.

[Amber] Nathan is progressing,

but he is definitely not eating the right things.

And when I saw him starting to make the wrong choices,

my whole body was like, "I hope he throws his guts up

and I hope it comes out his nose."

Only because he needs to know what that feels like.

I'm not on liquids.

So I just eat what I eat. And if it tempts him?

You know, hey, if he's gonna do it, he's gonna do it,

and he's gonna have to see for himself.

Amber's told me I'm making her worried

because of some of my recent food choices.

I know I'm still losing weight because my clothes are bigger.

So I'm not concerned about my progress.

I'm concerned a little about hers, to be honest.

I've seen her struggle this past month.

She's made some choices that aren't a part of the diet plan.

By next month, if she doesn't make it to her weight loss goal,

I'm scared she won't get the surgery.

And it's important to me that she does that,

so we're able to keep doing this together.

-You done? -I don't know, I think so.

When you had your surgery, how did you feel like?

What did your body do when you were like, "Oh, I'm done"?

For me, if I even smelt the food,

another bite, like, I would be sick.

I need to learn to listen to my body.

I think that's part of the problem.

Could be.

Amber and I are back in Houston

to go to our next appointment with Dr. Now.

And I'm nervous.

Because I don't know what the scale's gonna show for either of us.

I know I've been losing

because of the weight loss surgery

and how little it lets me eat.

And I know Amber's been working hard.

So I'm just hoping that we both have some good progress today.

Nathan and Amber.

[Nathan] At the time of my surgery, I was at 521,

and Dr. Now told me I should lose 40 pounds

the first month after my surgery.

-Me first? -You first.

[Nathan] So to be on track, I should be down to 481 today.

I'm a bit speechless, because I don't see how I lost so little.

I had known that I've made some poor choices

before I came in here,

but I didn't realize it was as bad as it had been.

[Amber] I had a feeling this was gonna happen.

I tried to tell him, but all I could do is control me.

At my last appointment, I was at 502.

And Dr. Now told me to lose 50 pounds

in order to get approved for my revision.

So that means I have to be at 452 today.

That's disappointing, to say the least.

I am not happy about that.

[Nathan] I don't think today's gonna go like I hoped.

So that's disappointing, but we both have no one to blame but ourselves.

So we just need to take responsibility.

And work to fix it because that's all we can do right now.

-Hello, how are you all doing? -[both] Good.

All right, let's see what we got with your own progress.

With Nathan, starting with you.

This is about a month after surgery.

And you have lost...

the whole six pounds instead of 40.

So what's going on that you only lost six pounds

in one month after weight loss surgery?

I... Honestly, the only thing I can think of is that

I've... probably eaten stuff that I shouldn't have.

-Like what? -Um... [clicks tongue]

[chuckles] I had mashed potatoes.

I've had macaroni and cheese.

And so you're in the Stage 2 of diet,

which is an only-liquid diet.

But you're eating mashed potato, and macaroni and cheese.

-Mmmhmm. -So which part of that

is making sense to you?

-None of it. -Were you hungry?

Yeah, I was.

I guarantee that's not the physical hunger.

That's a psychological hunger.

So in one month after surgery, losing six pounds.

That mean next month, you're gonna start gaining weight.

That's not gonna happen, but--

Let me put something to you.

You just had an operation that take away your physical hunger

and prevents you from overeating.

And you hardly lost anything,

so that is exactly what's gonna happen.

And you're not seeing the reality of that.

Right.

You're going through all these things, and you work hard

and got a second chance to get your life back,

but now you throw it away

and going back to killing yourself with food.

What are we gonna do to change that?

Uh, not make those choices anymore? Work harder?

Why should I believe you're gonna follow through this time?

I feel like I let a lot of people down, and...

I don't like feeling that way.

So... in order for me not to feel that way anymore,

I'm gonna have to do exactly what I'm supposed to do

and continue to get better at it.

Okay. But this isn't all dependent on you, though.

Because you both have to do this

and support each other. Okay?

Then let's change the gear.

-Amber. -I did horrible, sir. Horrible.

Wait a minute. You,

instead of losing weight... We give you all the tools.

You already had one weight loss surgery.

-And you gained three pounds. -Yes.

So what is going on in this household?

So, [sighs] for me, I...

panicked. And I literally...

did not get out of bed. I didn't...

count my calories or anything for two weeks,

which is... The proof is right there.

I just gave up,

and I should not have done that at all.

None of this stuff you saying make any sense.

And, ultimately, there is no excuse

that justifies being unhealthy

to the point you're killing yourself like this.

So nothing and no event in your life

justify overeating.

But you're justifying to yourself.

So you're convincing yourself,

"It's okay to overeat because of this issue."

But this issue is not reality.

The bigger issue I'm concerned about is that

it's clear that there's something going on in the household

that both of you encouraging each other to overeat.

I don't see how you all gonna change that environment

that you have built over years for pathological eating.

Well, I know I can do it.

I haven't, but I know I can.

Well, you know, I know I can go to moon, too.

[chuckles]

But what is the practical reality of that?

That's gonna happen?

-Yeah, I can go. -[Nathan] Right.

If you give me a rocket, I will go.

But that's gonna be reality? No, it's not.

And a figure of speech isn't gonna change anything.

I know. Talk is cheap.

You know, I can tell you whatever I wanna tell you here, but until I do it,

you're... Nobody's gonna believe it.

Okay. Amber, what's the solution for you?

I just have to get back at it and prove to you that...

That I was on the right track to begin with

and that I'm not gonna fail you again.

Well, I can't believe any word you're saying

-or Nathan's saying... -[Amber] Mmmhmm.

...until I see some action.

Right.

-Understood. -Okay?

And, Nathan, you went off the rail quicker after surgery

than anybody I have ever seen.

So, at this point,

I'm disappointed for both of you,

so I'm gonna give you both two months

to get back on track, okay?

Which means that from here on out, Nathan,

you lose at least 20 pounds a month.

And for you, Amber, you should be able to lose

the 50-pound goal I gave you.

If I don't see that progress,

I know nothing else is gonna work.

-Yes, sir. -All right? So...

Uh, you know, this is your life,

and the only wealth in this world you got is your health.

And you're throwing it away by overeating

and killing yourself on the food

and making excuses that are acceptable to yourself,

not to anybody else.

So it's totally up to you both to make the changes

and change your life around before it's too late.

If you keep this up, I guarantee you

neither of you will be here five years from now.

And this is the easy choice,

in that you have to see the reality of it.

-Okay? I'm gonna set you up both to see a therapist. -Yes, sir.

-Okay? -[Nathan] Yes, sir.

Because maybe they'll be able to help you all

on your negative dynamic. Okay?

-Are we clear about what's going on? -[both] Yes, sir.

Okay, we'll set that up.

And both of you need to do everything you can

to get on track now.

Yes, sir.

In the meantime, if you need anything, give me a call.

-[both] Yes, sir. -All right.

-[Amber] Thank you. -[Dr. Now] Mmmhmm.

We have a very unfortunate situation with Nathan and Amber.

For Nathan, I've never seen someone

work against weight loss surgery like he has,

especially in such a dangerous way

so soon after the operation.

Because at this point,

there is not only no physical drive to eat for him,

but it is actually a painful process

to try to eat solid food

that soon after surgery.

So there are deeper issues at play here.

And I think Amber's influence

on both her and Nathan's eating habits

is much greater than they both realize and she admits.

Because I'm starting to think

she may primarily be a negative influence

on their unhealthy habits.

But she seems to blame Nathan for all that.

And Nathan seems to accept that.

So the dynamic between them

is looking like it is a more intricate issue

that is going to be more difficult to address.

Hopefully, therapy will help with that

because they both are in a very dangerous place,

where they are about to self-destruct

unless they turn things around now.

And if they don't do that immediately,

then I don't think there'll be anything we can do

to stop them both from going right back

to the same situation

and an unhealthy dynamic they have had for years.

So this is a very dark situation with them

that we will, hopefully, help to turn around right now

before it's too late.

[Nathan] Amber and I are headed to the couples therapy

that Dr. Now wanted us to go to.

[door squeaking]

Hi, folks. I'm Dr. Paradise. Come on in.

[Amber] Hi, nice to meet you.

[Nathan] And if there's something that will help us, I'm ready to do it.

Thank you.

But it's definitely a little scary.

-Okay. -Welcome.

Glad to see you guys. How'd you guys meet?

Her cousin was in my drama program, introduced us.

Our first date was at her house.

She cooked me one of my favorite meals.

And rest is history.

So food... Food was from the very beginning.

You guys are both already big.

You... You won him over with dinner.

I guess so. [laughs]

What made you attracted to each other?

I... I think she's strong.

The strength that I wish I had, I... I see in her.

What did you see in him?

He's very levelheaded, very grounded,

um, and very spirit oriented,

which was something that I felt like I had to have

'cause I was in a very, very toxic relationship

for a very long time.

-So you were counting on him to be a good guy. -Yeah.

Um, tell me about your physical relationship.

Uh, right now, it's nonexistent.

How was it at the beginning?

Well, I've always been big.

-And, like, right now, I have a lymphedema growth... -[Dr. Paradise] Okay.

...that sits right on my abdomen

-right above that area. -Okay.

So there's no way it's possible.

-Blocked off. -Yep.

You know, when we married,

everything that we attempted just didn't physically work.

Okay. So you seem resigned to it.

It's just not at the top of our priority list.

It never really has been.

-Is that okay with... With you? -Not really.

Okay. I'm worried, Amber, that you seem pretty shut off

from that part of a relationship

Yeah, I... I am.

And, you know... [stammers] It certainly my intent

when you guys came in was not to do,

like, Dr. Ruth with you guys.

But in most relationships,

it's often the elephant in the room.

Somebody's not getting what they want in the bedroom.

And that will cause ripples of conflict.

Uh, I think neither one of us are getting what we want there.

What happened?

Where... Where did it go off the rail?

I think I know one of the... The things.

Uh, before this whole experience with Dr. Now,

I was supposed to have the surgery.

-I was losing the weight. I was doing great. -Yep.

And then the doctor cancelled the surgery

because I didn't have the $2,000 payment.

-His... His copay, yeah. -Ya didn't have the money. Okay. Mmmhmm.

I... I basically just got depressed,

and it got hard to do things.

-And I didn't wanna do a lot. -And your self-esteem...

Weight goes up, self-esteem goes down.

Mmmhmm.

And that's not attractive to you, is it?

No.

She called me disgusting, a bad husband, all that stuff

because I gave up and went back to food.

Does she respect you?

[Amber] No. Probably not.

Wow!

I... I didn't want to answer that

'cause I didn't want to upset her.

No, probably not. Not, not... No. No.

I just want her to be proud of me.

Why should she be proud of you?

So, Nathan, you're a great guy!

But I haven't seen you stick up for yourself.

If you don't stick up for yourself,

it's hard for people, even your wife,

to respect you.

And so we gotta get you stickin' up for yourself.

And that may involve sticking up to her.

Is she helping you lose weight?

I would say she is.

'Cause sometimes a partner will undermine somebody's weight loss.

No, I need her to be more forceful when it comes to that.

-But I'm not gonna do that. -You don't...

You don't need her to do anything.

You gotta leave her out of it.

Start advocating for yourself.

It's gonna make her respect you more.

And the number one thing you can do for yourself now is what?

-Lose the weight! -Oh, okay.

So in service of this idea of... Of being independent,

I wonder if you guys could actually plan separate meals.

Plan separate shopping trips.

How does that sound to you?

It worries me

because that's one of the only things

that we do together.

Your most unhealthy habit

is the thing that links you guys together.

[Nathan] Mmmhmm.

So I need you to... To break it apart.

I need you to eat by yourself.

And you're gonna have to find something else to bond with.

Work for you?

Okay, thank you for comin'.

Thank you. Got it?

Nathan's a really articulate guy,

and I'm impressed with what he has to say.

I'm worried that the more he tries to get Amber to like him,

the less she really likes him.

There's something in their relationship

that's incapacitating him

in terms of sticking up for himself

and even just feeling good about himself,

feeling like he's worth sticking up for.

[Nathan] There were a couple of things in the appointment

that were new to me.

The main thing that was new to me was the idea

that Amber didn't respect me.

I... I mean, I've always, to some degree, felt it,

but that's the first time it was said out loud and put into words.

I guess I'm a traditionalist in some sort of the sense

when it comes to marriage.

I feel like we should want to do everything together.

It just makes me feel like

I'm drifting further away from Amber.

How fast do you want me to go?

Just go whatever's com... 1 mile per hour, 1.5.

Whatever you feel.

Just two or three minutes, get ya movin'.

[Nathan] It's been a few weeks

since we've had our appointment with Dr. Paradise.

And since then Amber and I have been focusing

on the things that he told us to do.

Here's your stretching pull, man.

[Nathan] It's been an adjustment,

and I'm still working on it.

But I will say I've been proud of myself

for how much I've been doing on my own

and how well I'm doing at it.

-Feeling pretty good? -Yeah.

All right.

[Nathan] But I joined a gym, and I got a trainer

so I can push myself to do even more with my exercises.

But at the same time, when I'm here and I hit a new goal,

what I wanna do is turn and tell Amber.

And then I wish she was here.

Two more time.

[Nathan] And I'm working to see myself as someone

who isn't dependent on anyone else

because I know Amber isn't going to respect me

until I can respect myself.

I'm trying to change my life, and I'm trying to get better.

And I'm trusting that it's gonna be for the best.

But it's scary...

One more time. Come on!

-[effort grunts] -That's it!

...because it feels like I'm losing Amber right now.

Good job, man.

-Thank you. -Proud of you.

[Nathan] I'm in Houston for the appointment with Dr. Now.

Amber couldn't make it today because she had to work.

She got a new job this past month.

And she wasn't expecting to have to work today.

So she thought she was gonna be free today.

But I know that he's gonna think

that she's trying to avoid him or avoid the scale.

But that's not what's going on

because this is important to her.

Nathan.

[grunts]

-[Nathan] Hello. -Hello.

-[Nathan] How are you? -I'm okay.

[Nathan] At the last appointment, two months ago, I was at 515,

and Dr. Now says I should be losing

at least 20 pounds a month.

We're gonna weigh you, okay? Let me just zero it out.

Okay, step up on the scale.

[Nathan] That means I need to have lost 40 pounds by today

to be under 475.

So I'm hoping that's the number I made it down to.

-We're gonna be going to Room 5 please. -Yes, ma'am.

[Nathan] Well, it's a lot better than just six pounds the last,

so I'm happy about that.

But I'm not sure how Dr. Now will feel about it.

Hopefully, he sees the positive.

But we'll see.

Hi, Nathan, how you doing today?

I'm good. How are you doin'?

Good. So where is Amber today?

She couldn't make it because of work.

But this appointment has been scheduled for a while now.

And she knew that if she needed to be free.

She could easily have been available to be here

if she wanted to.

Or she could have called to reschedule.

So I think the issue is she didn't wanna come today.

So why that?

I... I think she might have been a little nervous about her weight

and seeing how she was doing.

Is she making the changes that she needs?

Some. She's struggling, uh, but we both are.

Well, you came here today,

and you're making some progress.

You lost, uh, 28 pounds.

So it looks like you're losing about 14 pounds a month,

which is closer to what you should be losing

two, three months after weight loss surgery.

But you still have a little ways to go

to be losing 20 pounds a month like you should be.

Nathan, do you think that therapy's helping?

Uh, it was hard, um, but it was really good.

It made us really look at how we are as a couple

and work on that.

So you're gonna continue that?

Uh, yes, I'm gonna have an appointment pretty soon

to continue working on that.

Good.

But Amber shouldn't skip that appointment either.

You know, Amber is gonna be here next time.

All right, no more excuses that she couldn't make it.

I know that she wants to do this.

She'll be here next time.

We're... We're both in this 100%.

Okay, keep up the good work,

and I will see you in two months.

And if you need anything before that, give me a call.

Yes, sir, will do.

-All right, I'll see you then. -Yes, sir.

[Dr. Now] I'm happy to see that Nathan has improved his progress

and that he's moving in a positive direction.

That shows he's taking some responsibility for himself

to seek to the changes he needs.

But I'm obviously concerned about Amber right now

because there was no good reason

for her to have missed the appointment today.

Because if they both don't do what they need

to change their life,

then it won't be likely that either of them

will be able to do this

for the long term.

So the next appointment will be important,

because that will be a crossroad for Amber

that will determine things for her,

as well as Nathan.

[Nathan] Thankfully, Dr. Now is happy with my progress.

But I know I have some more ground to make up,

so my focus is going to be

on getting up to the 20 pounds a month weight loss goal.

He was suspicious about Amber

not being here like I thought he'd be.

But I know that we are both committed

to doing what we need to do in order to get healthy.

And thankfully, Dr. Now just kept the same goal for her.

And I know she'll be happy about that.

And I'm confident that by next time,

we are both going to be where we need to be.

Because I know we're giving everything we can

to make sure we can both keep moving forward.

[Nathan] Amber and I are back at Dr. Now's

for our next appointment.

And we're both a little nervous,

but we're both expecting to see progress today.

I've been trusting that all we are doing

is going to move us in the right direction.

Even when I feel like it's not.

So I'm hoping that trust and faith pays off for us today.

[Amber] I know I have a lot to prove to Dr. Now today,

and that's helped motivate me to stay on track.

Amber and Nathan.

[Amber] And so, I'm hoping it's all been enough

to get me to my goal today.

So I can show him I'm ready to do

what I need to get healthy.

And, hopefully, get my revision surgery soon.

Okay, Amber, you wanna step up on the scale.

We're gonna weigh you first.

Hold on, one sec.

Okay.

[Amber] The last time my weight

was at 505.

And my goal has been to lose 50 pounds.

So that would put me at

455 today.

If I hit that goal.

That's close,

and it's a lot of weight loss.

So I'm hoping Dr. Now is happy with that.

I know I worked hard for it.

[Nathan] I don't think Amber's happy with that,

but I think it's great.

She made great progress.

Step up on the scale, please.

[Nathan] So, hopefully, I did it too,

and I lost as much as her.

At my last appointment, two months ago,

I was at 487.

And I'm supposed to be losing 20 pounds a month.

To be on track, I should have lost 40 pounds

to be under 447 today.

What?

-Literally, ten pounds between us, that's crazy. -[Nathan] Yeah.

[Nathan] I'm proud of us.

I think we both did great. So I'm really happy right now.

Amber seems a little disappointed,

and a little down on herself.

But I think Dr. Now is going to be happy with us today.

[knock on door]

Hello. How are y'all doing?

-We're good. -Good. How are you?

All right. Well,

Amber I'm glad that you could make it this time.

Sorry, I've missed the last appointment.

It won't happen again.

[Dr. Now] All right. I'm glad to hear that.

And I'm glad to see that you're making some progress.

Thank you.

You both have been making progress.

So that's good.

So what is it helping you

to get back on track?

Uh, seeing Dr. Paradise,

and doing the therapy helped a lot.

He helped us realize that,

um, there were things that we needed to work on.

[Amber] The dynamic for us is different

than a lot of people.

[Nathan] So it was hard, but it was really good.

It made us really look at how we are as a couple,

and work on that.

We started putting those in place.

All right. So,

the key issue will be to continue that for a long term.

Yes.

All right. I'm glad to hear that.

All right. So Amber,

you're down to 461. So, essentially,

so far you've lost 40 pounds.

So that's a good progress,

and you need to keep it up.

Yes, sir. I will.

[Dr. Now] Here is what I'm willing to do.

We'll do an endoscopy on you to see how things are

with your first weight loss surgery you had when you were younger,

to see if a revision is possible.

There could be scar tissue or other reasons

preventing the revision

or another weigh loss surgery.

If everything looks good, I'll schedule you

for a weight loss surgery revision in two months.

-Okay. -And if you lost

another 25 pounds by then,

then we will move ahead with you.

But if not, we'll cancel it

and we will be back at square one with you.

-So, does that sound fair? -Yes, sir.

You think you can do that?

-Definitely, I can do that. -Okay. Great.

We will set that up and we'll go from there.

But I'm proud of both of your progress.

So keep up the good work.

-Yes, sir. -Okay?

-[Amber] Thank you. -All right.

Do you all have any questions?

-No, sir. -No.

Okay, Amber,

we will schedule your endoscopy,

and I will see you both soon.

In the meantime,

if you have any question, give me a call.

[both] Yes, sir.

-Thank you. -All right.

-I'll see you all later. -[both] All right.

All right, if you need anything, give me a call.

[both] Yes, sir.

I'm very happy to see the improved progress

with both Nathan and Amber.

I was initially concerned about Amber,

because of the fact she has already failed one weight loss surgery,

and because of the pattern I've seen from her,

where she seems to avoid responsibility for her part,

with the negative dynamic between her and Nathan.

But I'm glad to see that's not the case.

And that she is starting to make the changes she needs

to move in a positive direction with Nathan.

So we'll see how her endoscopy looks,

and how she does in the next couple of months,

and go from there.

But they are both doing well,

and I'm confident, Nathan is committed

to do this for the long run.

And if Amber can get to where she's ready

to take the next big step,

and get her revision,

then they will both have a fighting chance

to not only make the progress they need now,

but stick to it to be healthy for a lifetime.

[Amber] I'm here at the hospital for my endoscopy.

But I'm getting my weight checked on first

to see how I've been doing the past month.

[nurse] 454.2.

-Yeah, it works. -[nurse] 454.2.

[Amber] I'm still moving along and I'm getting there.

So, hopefully, that leads to me getting the revision.

Because I've been working really hard for it

and I know that's a tool I'm gonna need for the long term.

But it's all gonna come down

to how things are in my abdomen

from my last weight loss surgery, I guess.

I'm a little nervous because I really want to have the surgery.

But at the same time, you know,

this part is out of my hands.

So it will just be what it is.

But I'm confident

that if there's a way to do it,

Dr. Now will figure it out.

[Dr. Now] Today, we are doing endoscopy on Amber

to see if it's possible to do any sort of revision

or weight loss surgery on her

since she already had one when she was younger.

The issue that this can create is,

the first surgery can result in scar tissue.

That limits what we can do for a second surgery

especially, when it involves

stomach stapling like Amber describes.

So we are looking inside of her stomach,

and if the previous operation created any issues

that will prevent another weight loss surgery.

[Dr. Now speaking]

Let's begin.

Hold there.

Okay.

Move to the left some.

All right. Hold it there.

Her staple line is really narrow and long.

And so, it's gonna be an issue.

It isn't looking good.

Okay. We are done.

Amber has very difficult situation.

She has a previous gastroplasty,

which is a staple line,

which is very narrow staple line,

and leaving a very small stomach on one side.

That make it very difficult to work with that.

There is practically no way to do

a sleeve gastrectomy here

because staple line will make it so narrow that

she won't be able to swallow.

So, the only potential for revision

will be gastric bypass,

which is a more complex operation

than sleeve gastrectomy.

But it's the only option she has in her situation

because, essentially, she has very narrow staple line.

So the sleeve will result in a stomach

that is too narrow and too small

with the staple line that she got.

So the only option will be

that we do gastric bypass on her.

But that option is still gonna be difficult

because of those scar tissues she has.

But we can work with it to do a bypass

if Amber is gonna stay committed to doing what she needs

to make the second weight loss surgery

successful this time.

-Hi, Amber. -Hey, Dr. Now.

-You awake? -I'm awake.

All right. Well, we did the endoscopy.

You do have a very difficult situation

-because you got a narrow staple line... -Mmmhmm.

...which is about seven inches long.

And that is making it very, very difficult

to be able to correct that to sleeve

because we need more room for that.

Because it's so narrow, you can have reflux

and issue.

The only possible way

-is to convert that to a gastric bypass. -Okay.

So we'll schedule that for two months from now.

-All right. Sounds great. -I'll see you later.

-See you later. -Okay.

[Dr. Now] Right now, I'm encouraged by Amber's progress,

and I'm happy to see

Amber lost seven pounds over the last month.

So hopefully, she sticks to it

and we are able to move ahead with her weight loss surgery soon.

So that both she and Nathan

can take advantage of having the same tools

to continue to work together,

to be able to make the changes that will last a lifetime.

And from what I'm seeing now,

I'm optimistic that they'll be able to do that.

[Nathan] Amber and I had another appointment with Dr. Now today,

and it went well.

He says we are on track.

And the really good news is that

he scheduled Amber's surgery for next month.

So, we're both excited about that.

I told Amber that I wanted to stay the night in Houston.

So we could go out and have a date night in the city.

And a theater in the park sounded perfect.

[Amber] When Nathan told me his idea to stay in Houston and go out,

I wasn't sure if it was a good idea.

Because I didn't know if this was gonna lead to any sort of temptation.

Because that's what we have always done together.

But I decided I was gonna keep an open mind.

[Nathan] We're not eating together.

But there are things that we can try to do

to bring some romance back into our relationship.

But I know that's gonna take time.

[Amber] I do think Nathan is on the right track

to him kind of going back to being

my husband, back like it was originally.

But it's a work in progress.

And maybe we'll get there.

Who knows?

It just depends on how things go.

I'm not gonna rush in, and I don't think he should either.

How you have been doing?

As far as what?

Just the whole process.

A lot better.

About a month ago, I wouldn't have been able to do this.

[Nathan] I know Amber and I have a lot to work on

to get back to a good place.

But with all my weight loss,

my relationship with my daughter, Hannah, has improved.

Because I'm actually able to go out

and spend time with her.

So we've been hiking together,

and going on nature walks at least twice a week.

And she keeps telling me she's proud of me.

When before, I think, she was a little embarrassed by me.

And I just hope that I can also become the husband that Amber deserves too.

One big step I'm taking

is I have decided to go back to work.

I still have my lymphedema

and it still hurts when I walk,

but it's gotten a little better.

I feel ready for it.

So I'm no longer taking a leave.

So I'm really excited about that,

and know as I make more progress,

I'm going to be able to do more and more

and I'm looking forward to all that.

So what are you gonna think about when I'm all skinny?

You're gonna look like a cartoon character.

With a big head, and a really skinny body.

[laughs]

[Nathan] How rude?

This is a journey.

One that involves much more than I could have realized,

as harder than I ever thought it would be.

But it's good and I'm happy to be on it,

and headed to where we're going.

Because I know it's a much better place.