Sarah Pabst, 20, of O'Fallon,Mo, undergoes a heart ultrasound to check her weight's effect on her organs. She is relieved to find out her heart is in good shape, but knows she needs to lose weight. " This is no way to live, it is a way to die. I am looking at a death sentence at 35 if I don't make changes," she says. Pabst tips the scale at 325 lbs, the heaviest she has ever been.