My 600-lb Life is a reality show on TLC that chronicles the weight-loss journey of the severely obese. The episodes follow individuals over the course of several months as their journeys progress.

This week, we see what may be the most complex situation of the season so far. The episode’s star, Karen, has grown too afraid to leave the house, putting her ability to attend medical appointments — and thus her ability to lose weight — at risk.

Karen Can’t Leave Her Home

This week we’re following Karen’s journey. She’s 42-years-old and lives in North Carolina, and right off the bat she tells the cameras that each time she goes to sleep, she’s unsure whether she’ll wake up again. A trend I’m noticing among the show’s stars is that they each describe merely existing as exceptionally painful.

Karen lives with her twin children, and she notes how guilty she feels about how much she must rely on them, constantly asking them to bring things to her. She says it’s been hard to stick to any kind of routine, and that her life is rather isolating:

Her daughter describes her as a stress eater, and, by her own admission, Karen says she is obsessed with eating and thinking about eating. When we learn more about her childhood, we see that food became a “security blanket” for her, something for her to lean on when she was feeling stressed or sad.

Karen said she felt so bad about herself that once, in her teen years, she allowed herself to be sexually abused, hoping it would make her accepted afterward. Instead, it only made her feel worse, and she went on to develop a severe eating disorder, binging and purging in a vicious cycle.

Now that Karen’s at her highest weight of all time and increasingly agoraphobic, she’s reached a turning point in her life and wants to make a change. Since she’s unable to see Dr. Now in person, they have a video call, where she tells him her short-term goal is to be able to attend her children’s high school graduation in person. Dr. Now is surprised to hear that Karen is likely more than 620 pounds, and he assigns her a high protein, no carb diet to start immediately.

Dr. Now tells the cameras that Karen’s situation has grown quite complex and will make it challenging for her to stick to her journey:

Karen Battles Her Inner Demons

As part of her journey, Karen meets with a therapist and shares how so much of her upbringing was focused on helping others instead of looking out for herself. The therapist points out that she appears to have bottled up a lot of past trauma, and that she’ll need to work through things so she’s less scared of going out into the world. As a start, she needs to start opening up her blackout curtains during the day and taking her dog for a walk.

With the help of her daughter, Karen practices leaving the house so she can make it to her health check-in without having a panic attack. Karen ends up missing her first appointment, however, and tells Dr. Now if she loses a little more weight, she believes she’ll be confident she’ll be able to come in. She tells him that she’s lost 100 pounds and that she’s doing everything he’s suggested, though he seems skeptical, and in fact we see her eating fast food as soon as she gets off their call.

Eventually Dr. Now sends someone to her house for a check-in, and she weighs in at 604 pounds. When her five-month mark rolls around, she’s able to make it into the car and onto the road with her daughter, but then she freezes up outside the office, unable to walk inside. At another at-home weigh-in, she clocks in at 583, falling short of her goal of losing 50 pounds. Seeing Karen falter again and again is incredibly frustrating to witness, but my heart goes out to her knowing how anxious she was in the moment.

Karen talks to Dr. Now, clearly in denial about her lack of progress. She says other people have commented on how much weight she’s lost, but he points out that because she’s too scared to leave the house, it’s unlikely she’s coming across people who can comment on her appearance. Once again Karen swears she’s committed to doing everything he’s prescribed, and they agree to meet in another two months.

For her last chance check-in, Karen only loses another ten pounds. Because she failed to reach her goal, Dr. Now will refuse to work with her going forward. She once again accuses the scale of being wrong, but he tells her that not being willing to believe the scale really means she’s not willing to believe in herself. Karen claims that she’ll be able to continue her journey on her own, and at the end of the episode we’re left wondering how, exactly, she’ll go about it.

My 600 Lb Life

Release Date

February 1, 2012

Network

TLC

Seasons

11

Streaming Service(s)

TLC GO

Showrunner

Jonathan Nowzaradan

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