In a recent update on Sean Milliken of "My 600-lb Life," Dr. Nowzaradan did something he's never done before, and it shocked viewers and commenters. The 900-lb Sean failed weight-loss, gained back all of the 300 pounds he lost, and was still immobile after bariatric surgery. But Dr. Now didn't blame him. In fact, he defended Milliken and blamed someone else entirely. Who did Dr. Now fault for the bedridden man's obesity?

Dr. Now chews out mom for Sean Milliken's weight-loss

Sean's story on "My 600-lb Life" is one of the reality television show's most bizarre and quixotic. Many patients like Steven Assanti and James K., come to Dr. Now full of blame for others and self-pity.

The bariatric surgeon has to help them learn to take responsibility for their own health and weight-loss. He addresses the dangerous way their enabling caregivers feed, wait on, and clean up after them. He helps family see their codependency on the food addict's behavior. The reality TV physician holds them accoutable but he doesn't exclusively blame them. Except in Sean's story: Dr. Now went after Sean's controlling mother Renee. He told her point-blank that not only was she killing her son, she was doing it purposely.

Dr. Now nails insincere, manipulative mom

Even the normally imperturbable Dr. Now seemed shocked at how much weight Sean Milliken gained. After gastric bypass surgery on TLC's "My 600-lb Life," the young man lost 300 pounds, and he'd put it all back on. He also still hadn't gotten out of bed and even went to the bathroom in a bucket hanging on the side of the bed.

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When the reality TV doc confronted Sean's obesity, Renee was mystified and very maternal. She was pretty sure she fed him only 1,200 calories a day. Renee kept saying that her son had just stopped losing when in fact he'd gained hundreds of pounds and weighed nearly a half-ton. Mom said all the right things but Dr. Nowzaradan didn't buy her sincerity and basically accused her of malicious abuse.

Dr. Now identifies Munchausen Syndrome?

Renee acted worried but also patronizing and passive-aggressive. When the "My 600-lb Life" counselor pointed out how Sean and Renee said "we" and "our" when it was Sean's problem, she breezily agreed she needed to separate. Renee backhandedly commented that he really wasn't much help, even though she already knew that. Mom blamed Sean' father for weight problems and made excuses that an old injury kept Sean bedridden. The TLC mom admitted making him stay in bed to heal some unconfirmed illness and referred vaguely to mysterious pain. Finally, she said she didn't care about weight-loss anymore and only wanted her son to get better. Dr. Now pointed out that fixing obesity was the way to do that. Is Renee controlling her gullible, immature son with fear-mongering? Is the reality TV mom a case of Munchausen Syndrome by proxy? The term wasn't used but it was implied, and Dr. Now suggested that mom needs therapy as much (or more) than her son.