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Food: The Secret Struggle

Aired March 9, 2007 - 20:00   ET


PAULA ZAHN, CNN ANCHOR: Good evening, everyone. Thanks so much for joining us.
Tonight: a very special hour on problems that millions of Americans desperately try to hide. We are calling it "Food: The Secret Struggle."

Out in the open tonight: the shocking truth about this country's most common eating disorder.

Also, should the government start taking obese children away from their parents?

And when exercise is bad for you. For a "Sopranos" star, it was a sign that something was terribly, terribly wrong.

First tonight, some fascinating new information about our nation's number-one eating disorder. You might be surprised to learn it's not anorexia, not bulimia. It is binge-eating, feeding yourself enormous amounts of food all at one time.

According to a new Harvard study, nearly six million Americans do it. But, until now, it's been so shameful, so secretive, that most people wouldn't even talk about it.

Tonight, medical correspondent Elizabeth Cohen brings binge- eating out in the open.


ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT (voice over): Until just a few months ago, Natalie would go on wild food binges, eating ice cream, potato chips, cookies.

NATALIE, RECOVERING BINGE EATER: A sleeve of Ritz Crackers with peanut butter, Triscuits, you know, some cheese from the refrigerator, maybe some cream cheese straight out of the carton, maybe some mayonnaise right out of the jar.

COHEN: For more than 10 years, Natalie lived in shame.

NATALIE: And I would buy foods from -- you know, from different stores and stop in different places, so that nobody would -- you know, would know that I was getting -- no one could really track me. I -- I really needed to be anonymous in my eating.

COHEN: She binged in private -- her family and friends never guessing her secret.

NATALIE: They have never seen me binging, because I have hidden it.

COHEN: Secrecy, a hallmark of binge-eating, helps explain why few people realize that binge-eating has become America's most common eating disorder, more common than anorexia or bulimia. That's according to a new Harvard study, which finds that one in 35 Americans suffers from regular binge-eating.

We all overeat at times. How is binge-eating different? Experts say binge-eaters eat as if in a trance, thousands of calories in just a few hours, so much that, sometimes, they just pass out, like Natalie says she did nearly every day for several years.

NATALIE: It's almost like a feeling of being drunk. I felt some kind of -- some kind of high, sometimes, out of eating like this. But, afterwards, I felt really terrible about myself.

COHEN: Unlike bulimics, binge-eaters don't purge. Some become obese, but others, like Natalie, figure out a way to keep their weight under control to hide their secret.

NATALIE: I would take walks up and down the entire island of Manhattan. I would walk the length of Manhattan.

COHEN: As binge-eating is starting to come out in the open, therapists are beginning to learn why people do this to themselves.

DR. LINDA CRAIGHEAD, PSYCHOLOGIST: The person is eating, in a sense, to distract from or numb their feelings. It is a very -- it's a form of emotional eating.

COHEN: Dr. Linda Craighead treats binge-eaters and wrote a book on binge-eating. She says we live in a culture that makes it easy to eat junk.

CRAIGHEAD: We have what we call a toxic food environment. We have huge amounts of high-fat, very tasty, inexpensive, easily available food.

COHEN: She says the key to recovery is identifying the emotional reasons for binging.

Natalie realized she ate to cope with stress at school. With the help of a support group, she says she hasn't gone on a binge in seven months.


ZAHN: It is so painful, Elizabeth, to hear her talk about eating so much, she passes out. It almost sounds like a drug addict or an alcoholic.

I guess what a lot of us want to know, is this addiction related to food, or obsessive compulsive -- some -- something obsessive compulsive?

COHEN: Right. Is it about hunger or is it about addiction? That's the question that doctors had.

And, so, they decided to put it to the test. They thought, well, it must be hunger. And, so, they put obese people in a PET scan. They made sure that their stomachs felt full, and then they did scans. And they expected to see the hypothalamus light up, because that's an area that has to do with hunger. But that's not what they saw.

What they saw was an area of the brain called the hippocampus light up. And that's an area that has to do with sensory issues, that has to do with addiction. So, they really think that it does have to do with addiction.

And Natalie, who you saw in that piece, she said to me: Elizabeth, when I would binge, I would go on a high.

She really described it like people described doing drugs.

ZAHN: Well, it sounds like she is in a positive place, if she hasn't...

COHEN: She is now.

ZAHN: ... binged in seven months.

COHEN: She is now.

ZAHN: We wish her luck.

We are going to turn right now to a group of people who simply can't stop eating. And it's not because they are addicted to food, but because, in fact, they are constantly hungry.

It's a fascinating story, Elizabeth, I know you have been following for quite some time.

COHEN: That's right.

If you can imagine, imagine spending every waking moment in constant hunger, eating meal after meal, and never feeling full. It's called Prader-Willi syndrome And it's a debilitating disorder that makes people constantly desperate to eat, no matter what, no matter where.



ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT (voice-over): The sound of the local ice cream truck makes most children smile, but that sound is torture for Maribel Rivera. She's desperate for ice cream, or anything else to eat, tormented by a constant hunger that never, ever goes away. And it's not all in her head. Scientists have discovered that people like Maribel are missing a piece of genetic material. They're mentally challenged, and they're always hungry.

Bronnie Maurer's son, Andy, has always lived with that nonstop hunger since he was a child.

BRONNIE MAURER, MOTHER OF ANDY MAURER: And when you think, "I have to get something to eat," they're never without that feeling.

COHEN (on camera): What is it like being hungry all the time?

ANDY MAURER, SUFFERER OF PRADER-WILLI SYNDROME: It's terrible. I don't know anything else that's so embarrassing.

COHEN: Some people might think, why can't you just control yourself? If I see a donut, I just don't eat it. Why can't you do that?

MAURER: Can't, because it's -- it's there. It's a compulsion, the need, the urge to get the food.

COHEN (voice-over): After 46 years, he's finally begun to learn how to live with that urge.

MAURER: Most of the time, I can control it.

COHEN: But Maribel's long, difficult journey might never reach that point. When Maribel was born, she didn't cry and she didn't nurse. Doctors struggled with what was wrong.

All signs pointed to a genetic disorder called Prader-Willi syndrome that affects one in 15,000 people.

Dr. Suzanne Cassidy is a medical geneticist and a professor of pediatrics at the University of California San Francisco.

DR. SUZANNE CASSIDY, MEDICAL GENETICIST: Individuals with Prader-Willi syndrome have a period of what we call failure to thrive. They tend to have very poor growth, first in weight and then in length, for a number of weeks or months in infancy. And, some time between 1 and 6 years of age, it seems, all of a sudden, one day, the child starts eating whatever they can get their hands on.

MARIBEL RIVERA: Yes, buy me a hot dog, please.

COHEN: Maribel's older sister made a documentary about her 24- year struggle with Prader-Willi syndrome. She caught this startling moment.

MARIBEL RIVERA: Will you buy me one, a hot dog, please? I'm so hungry.

UNIDENTIFIED FEMALE: Where's your parents?

MARIBEL RIVERA: I don't have no parents. Please. UNIDENTIFIED FEMALE: OK.

MARIBEL RIVERA: Please? Thank you. Thank you. I want ketchup.

COHEN: By the time Maribel was 23, she stood 4'10'' and weighed 235 pounds. She had trouble breathing and was diagnosed with diabetes. Her parents checked her into a hospital.

MERCEDES RIVERA, MARIBEL'S MOTHER: When she first was admitted into the hospital, she was stealing from patients. She was stealing from even the trash.

COHEN: There's no cure for Prader-Willi syndrome. The Riveras realized that the only place that could regulate Maribel's disorder was a group home, where she could be watched around the clock.

CASSIDY: When such individuals get put into a group home for adults, especially with Prader-Willi syndrome, this is when I have seen the most amazing weight loss and increase in fitness.

The food is locked up. It's not available between meals and snacks. Everybody in the home is on a diet, not just that one person.

COHEN: The adjustment to this new place will be difficult, but the first signs are good.

MARIBEL RIVERA: I think I want to stay here.

COHEN: Leaving Maribel behind will be hard for her family, but they know that this decision could save her life.


ZAHN: So, Elizabeth, I know you have been tracking both Maribel and and -- Andy. How are they doing now in treatment?

COHEN: They are doing really well. Andy has kept his weight off. And Maribel, you saw how happy she was to be in that group home in Wisconsin. In about a year-and-a-half, she's lost about 70 pounds. So, it is really working well for her.

ZAHN: That's fantastic.

COHEN: It's great.

ZAHN: Hope she keeps it off.

It's interesting, because these conditions you have just described with Andy and Maribel are -- are quite extreme. But isn't it true that scientists are studying their brains to shed some light about why the general population in America eats so much...

COHEN: Exactly.

ZAHN: ... and why the obesity rate is so high? COHEN: Right, because doctors don't know why most Americans eat too much. They don't -- they don't know the scientific reason behind it.

But, for people like Andy and Maribel, they do know. They know exactly what chromosomal material they are missing. So, they can take that DNA information. They can scan their brains. They can look at insulin levels. And they can figure out what's going on in their bodies. And, from there, they can try to extrapolate to what might be wrong with other people who eat too much.

ZAHN: Do they have any idea how long it will take to gain that understanding...


ZAHN: ... so we can bring this horrendous obesity rate down in this country?

COHEN: It will take quite a while, because you're starting -- it's -- it's very basic science. They are really at the beginning of learning how the brain and the body interact with hunger, why we can't listen to our brains when they tell us: Stop eating. Put down the fork.

It's going to take a while.

ZAHN: We also heard one of those doctors in your piece describe that -- that the huge -- the biggest challenge, of course, is the accessibility of food. And there is so much bad, unhealthy stuff so readily available.

COHEN: Right.

There are probably many people who could benefit from a home like where Andy and Maribel are, where, you saw, they lock it up. I mean, that food is locked up. They cannot get to it. Of course, that can't happen with the rest of us.

But it's true. When you walk into a food mall in a -- in a -- in a mall, the food court, there's just so much there. I mean, we are not built to resist that. We are built to eat. We are built to have fat to keep us going as human beings. But Mother Nature never -- never intended us to have quite this much food so available.

ZAHN: We don't need a food court in New York City. You walk two blocks, and...

COHEN: That's right. That's enough.

ZAHN: ... and you get assaulted with every bad thing that...

COHEN: That's right.

ZAHN: ... shouldn't go into your mouth.

Elizabeth Cohen, stay with me, because we need your expertise throughout the hour.

Coming up next in our special hour, "Food: The Secret Struggle": a dramatic new legal case. If you are giving your kids too much pizza, should the government take those children away from you?

Then, a little bit later on: the hidden truth about a disorder that, until now, most people associated with teenagers. We will bring adult anorexia out in the open.


ZAHN: All right.

I know you have all heard of sleepwalking, maybe even do it. But how about sleep-eating? In a short while, we are going to bring it out in the open as a part of tonight's special hour, "Food: The Secret Struggle."

Up first, the alarming increase in childhood obesity in this country is forcing some officials to take drastic steps, like sending kids home with obesity report cards. But it's also a growing problem in Britain, where officials were so concerned about the health of one very overweight boy, they threatened to take him away from his mother.

Alphonso Van Marsh has that story.


ALPHONSO VAN MARSH, CNN CORRESPONDENT (voice-over): British authorities say, unless Connor McCreaddie, who weighs almost 200 pounds, starts doing less of this, and more of this, he is at risk of dying at a young age.

Connor is just 8, but weighs nearly four times an average boy his age. For years, Connor's mother let him eat what he wanted when he wanted.

NICOLA MCKEOWN, MOTHER OF CONNOR MCCREADDIE: We don't mention fat in this house.

VAN MARSH: And, until recently, no mention of fruit, or fresh, or fat-free either.

Connor long enjoyed high-calorie fried and processed foods, until authorities, after implying neglect, cut a deal with Connor's mother to stop serving the fat, or risk losing him to protective care.

MCKEOWN: If I had neglected Connor, he would be a skinny kid, a skinny little runt.

VAN MARSH: Social services wouldn't talk to CNN, but issued a statement, acknowledging Connor gets to stay with his mother for now.

In the United Kingdom, with one of the highest child obesity rates in Europe, the state intervention had even child anti-obesity campaigners alarmed. TAM FRY, HONORARY CHAIRMAN, CHILD GROWTH FOUNDATION: I think it's going to be a wakeup call, because I think that there will be a lot of parents who now say: We ought to do something before social services coming knocking on -- knocking on the door.

VAN MARSH: The United Kingdom is catching up to the United States when it comes to overeating. Some experts argue, a third of children here are dangerously overweight.

PAUL SACHER, CO-FOUNDER, MEND: You would actually do more harm than good.

VAN MARSH: Paul Sacher runs an intervention program for obese kids.

SACHER: You're going to -- there are going to be many other consequences of removing a child.

VAN MARSH: It includes teaching families how to shop for healthier foods. Sacher says, don't entirely blame Connor's mother for Connor's obesity.

SACHER: And let's face it. Many adults today don't know what a healthy diet is for themselves, let alone what they should be feeding their children. Western society now, it currently makes it easier to be unhealthy than it does to be healthy.

VAN MARSH: That's why parental participation is mandatory in Paul Sacher's MEND program.

UNIDENTIFIED MALE: Yes. You pick the kids from school. You go straight for the shopping, yes.



UNIDENTIFIED MALE: And, in there, they mess up with their diet and everything.


VAN MARSH: While adults learn to avoid serving pre-packaged meals and takeout, the children learn how to lead more fit, more healthy lives.

(on camera): The MEND program already has kids moving in over 40 sites across the country. They say they hope to open 300 sites by the end of next year.

(voice-over): It's not a stretch to say Connor has a long road ahead of him. There are many public and private programs that can help, but, in the end, it will really depend on Connor getting support at home or in protective care in a fight against obesity that some say could kill him.

Alphonso Van Marsh, CNN, London.


ZAHN: I guess it was stunning for all of us to see what he ate, I mean, extraordinary amounts of pizza and bacon and eggs and rolls and processed meat. The list went on and on.

And -- and, you know, we all make so much about the issue of vanity. But -- but the really scary issue involved here, of course, are the health consequences: high blood pressure, diabetes. But there are even more severe risks.

COHEN: Right.

As this generation gets older, doctors are adding to the list. For example, just last week, there was a study, Paula, that said that overweight girls are hitting puberty earlier than the girls who aren't overweight. And the reason for that is, is that more fat needs more estrogen. So, those girls hit puberty earlier.

Now, there's probably going to more added to the list as the years go on. Doctors already know that this could be the first generation in a very long time that has a shorter life expectancy than their parents, all because of obesity.

ZAHN: Those are some pretty stunning numbers to turn around.

COHEN: They are.

ZAHN: We got our work cut out for us.

COHEN: Certainly.

ZAHN: Internationally.

COHEN: Certainly.

ZAHN: Elizabeth, don't go away. We need your help throughout the hour.

Out in the open next: an eating disorder that everyone associates with teenage girls -- so, why it has started showing up in women in their 30s, and even older.

A little bit later on: people who eat thousands of calories while they are asleep. I'm not kidding you. You are not going to believe why that's possible.


ZAHN: Welcome back to our "Out in the Open" special, "Food: The Secret Struggle."

The National Institutes of Mental Health estimates, the number of women with anorexia may be as high as 5.5 million. Now, you may think that anorexia only affects teenagers or young women. But, as Randi Kaye found out, more and more women in their 30s and 40s are also struggling with the disorder.


RANDI KAYE, CNN CORRESPONDENT (voice-over): At 47, Becky Marsella is severely anorexic, one of a growing number of women over 35 who suffer from the illness.

Although she had never done so before, she says, she began starving herself six years ago, as she turned 40 and depression suddenly set in.

BECKY MARSELLA, BATTLING ANOREXIA: It was kind of just a senseless hopelessness that my life wasn't going anywhere, that I had just reach a point in my life where I couldn't get any more satisfaction out of just day-to-day living. It's like I needed something else, something that would just make me happy, something that I could be successful at.

KAYE: Becky was searching to take control of her life. The only thing she thought she could control was food and the amount she ate.

(on camera): If you look at yourself now, you have to wonder who is really controlling who? Are you controlling the food or is the food controlling you?

B. MARSELLA: The food and the disease has total control over me. I don't have control.

KAYE (voice-over): When her depression kicked in, Becky started exercising excessively. She only takes walks now. But, back then, she would sneak out in the middle of the night and run. She would run again before work and when she got home.

In spite of her husband's desperate efforts to help her, the weight of this 5'5'' Florida woman dropped to just 58 pounds.

(on camera): What do you remember about weighing 58 pounds? Do you remember?

B. MARSELLA: I remember being weak. I remember my skin just ripping off, my hair falling out.

KAYE (voice-over): But even that wasn't enough to shock Becky back into regular eating habits. Becky got so sick, she could barely hold herself up.

B. MARSELLA: I remember standing in the shower, and I got very lightheaded. The next thing I remember is waking up laying on the bathroom floor, with my husband over me. And my daughter was on the phone calling 911 for an ambulance.

KAYE (on camera): Back in October of 2003, Becky checked herself in here, to the Hyde Park Counseling Center in Tampa. She was treated by a counselor and a nutritionist. She wasn't allowed to take regular exercise classes with other eating disorder patients because her condition was so severe. But she was weighed every week.

(voice-over): Becky's no longer getting treatment, but her weight is up to more than 71 pounds.

(on camera): What is it like when you go out in public?

B. MARSELLA: It's hard. It's real hard. People stare. People talk. The hardest part for me is when the little kids see me.

KAYE: And what will they say?

B. MARSELLA: Oh, mommy, what's wrong with her? Look at her. What's wrong with her? Why does she look that way?

KAYE: That must break your heart.

MARSELLA: It's very hard.

DOUG BUNNELL, CLINICAL PSYCHOLOGIST: We are seeing an increase in the number of women, again, for the most part, coming into treatment in their 30s, 40s, 50s, and even 60s.

KAYE (voice-over): Psychologist Doug Bunnell works at a Renfrew Center for Eating Disorders. He's been treating eating disorder patients for 20 years. The center recently started a program to treat women over 35.

BUNNELL: When you think about other developmental shifts that go on in midlife, often, kids are growing up and leaving the house. Often -- well, we know, when that happens, the marriages have to be renegotiated. There's a -- sort of a quantum shift in how the relationship works. That can be upsetting or a -- a risky transition for a lot of people.

KAYE (on camera): Have you ever thought to yourself this could kill me?

B. MARSELLA: Mm-hmm. At night, my breath would be so shallow that I would just pray, you know, please let me wake up in the morning, because I don't feel like I can.

KAYE: Do you ever worry about losing her?

RACHEL MARSELLA, BECKY'S DAUGHTER: All the time, all the time, yes. It's terrifying to think that I might lose her. It's just -- I can't bear to even think about it.

KAYE: Becky's daughter, Rachel, understands what her mom is going through. Rachel used to work out and diet with her mom. Her own weight became dangerously low. At 5'11'', she weighed only 100 pounds

R. MARSELLA: I was starving every day, so hungry, so weak and tired. And I just -- I had to stop. I just quit it. KAYE: Rachel is frustrated she can't help her mom. Becky is still averaging just over 200 calories a day.

B. MARSELLA: I normally don't eat breakfast and lunch. I may have a handful of grapes or a couple carrots or a cracker. And, at dinner time, I may have something like an egg white and maybe some sauteed mushrooms.

People have good intentions. They're like: Just eat. Just pick up -- you know, go, get a milkshake. Go -- you know, go get hamburgers and french fries, and, you know, just eat. Just sit down and put the food in front of you and eat it.

And -- and you just -- you can't.

KAYE (on camera): So, what happens if you try to do that? What happens if you bring home a Whopper and Cheese?

B. MARSELLA: It will go in the garbage.

KAYE: You just can't eat it?

B. MARSELLA: Can't eat it.

It's like a little voice inside your head that will say, if you give in, if you eat that food, if people see you eating that food, they're going to think she's getting better. And to get better would be a sense of losing the control over denying myself the food.

KAYE (voice-over): Becky's family is seeing small improvements. She's trying to dine out once a week and struggling to stand up more often to the voice in her head telling her not to eat.

Randi Kaye, CNN, Tampa, Florida.


ZAHN: Elizabeth, I guess what I was amazed by, that she was so honest about what her challenge is like. Her case is so serious.

How many more women are there out there in this country in -- in this state of crisis?

COHEN: There are millions of women with this disease. And...

ZAHN: And -- and then this advanced?

COHEN: Not -- not as many are this advanced, but, certainly, there are many, many who are that advanced, and worse.

I mean, this disease actually has a very high death rate. It has got a higher mortality rate than all causes of death for women between the ages of 15 to 24 than any other psychiatric diseases. So, this -- this kills more women than any other psychiatric disease. And part of it is because of suicide. Sometimes, anorexics end up killing themselves. And part of it is just because their organs fail, because they become so thin.

ZAHN: I can't imagine how she can survive on 200 calories a day.

COHEN: Well, you see what she looks like.

I mean, what did Randi say, like around 70 pounds, I mean, for a full-grown women? And they just do.

I once had to -- I did a story with an anorexic who was about that size. We had to interview her while she was lying down. She did not have the energy to sit up and conduct an interview.

I remember another anorexic. She said: My mother put two sunflower seeds on a plate in front of me every day, like my nutritionist told her to. I cannot eat them. They are full of fat.

This girl weighed 80 pounds.


COHEN: And she said that she knew intellectually that that was crazy, but she couldn't do anything about it. Food was the enemy.

ZAHN: And I guess the sad thing about this is, so many people make assumptions about this disease. And they write it off as a disease of the wealthy. You know, who would ever abuse food this way?

But the truth is, there are such strong underlying psychological conditions that make it all but -- I don't want to say impossible, but really a challenge for someone like Becky to lick it.

COHEN: Right. Becky and her daughter were saying that people would say to them, "Why can't you just go out and get a burger? Why can't you just pick up the fork and eat?" Well, they just can't. They just see food as the enemy.

They're not doing it to get attention, they're not doing it to make their families angry. They simply can't eat. And that's the struggle the doctors face.

And even when people get good treatment and they've got the money to get the gold standard treatment, and they are in a center for month after month after month, still, they cannot get over it. It takes years and years to get over this disease.

ZAHN: Elizabeth, thanks. See you back here in our next segment.

We are going to take a short break here.

You might think that one way to avoid food is to sleep. But "Out in the Open" look at this video. What is turning some people into secret eaters without ever waking up? A nightly ritual in that household.

And a little bit later on, how a young actress secretly put her life in danger by exercising too much and barely eating at all. (COMMERCIAL BREAK)

ZAHN: In this half hour of our special, "Food: The Secret Struggle," an actress in a hit TV show and her hidden struggle to stay thin. Are you secretly doing what she did?

But right now, imagine waking up in the middle of the night sleepwalking into the kitchen, cooking, eating meals, and not remembering a thing about it in the morning.

Chief Medical Correspondent Dr. Sanjay Gupta brings us the scary phenomenon right "Out in the Open."


DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT (voice-over): It happens under the cover of darkness, during sleep. The mysterious use urge to eat.

For years doctors wondered how sleeping and eating could happen at the same time. Now two unpublished studies suggest that a possible cause may be the popular sleep drug, Ambien.

DR. CARLOS H. SCHENCK, MINNESOTA REGIONAL SLEEP DISORDER CENTER: Ever since Ambien came on the market, there was sporadic reports of sleepwalking being induced by the Ambien. And then there were some reports coming out about eating with the sleepwalking induced by the Ambien.

GUPTA: Six years ago Judie Evans began taking Ambien for insomnia. Soon after, curious side effects set in. She said that night after night, she would leave her bed and trudge like a zombie to the kitchen.

JUDIE EVANS, AMBIEN CAUSED TO SLEEP-EAT: I had gotten out of bed and I was cooking. I don't even like eggs, and I was cooking eggs and bacon.

GUPTA: Each night brought another trip to the kitchen, to make a sandwich, cook an elaborate meal and one time turning the oven up to 500 degrees.

Suspecting something was wrong, her son stayed awake. He was startled by what he saw.

EVANS: He told me what I had done. And I said, no way. I did not do that.

SCHENCK: In all cases, there is complete amnesia the next day. There is no recall whatsoever of what that person engaged in.

GUPTA: And Ambien may account for more than just sleep-eating. There have even been cases of sleep driving, says Dr. Carlos Schenck, who led the studies linking Ambien with abnormal sleep behaviors. Dr. Schenck said that in sleepwalking, sleep-eating and sleep driving, Ambien may confuse the brain. You can perform complex behaviors while the mind is partially asleep.

SCHENCK: You're acting like a zombie and you're rolling the dice. And whenever you roll the dice, it is very dangerous.

GUPTA: In a statement, Ambien's manufacturer, Sanofi Aventis, says it could not comment on specific cases, adding that " is difficult to determine with certainty whether a particular instance of sleepwalking is drug induced, spontaneous in origin, or a result of an underlying disorder."

Now, this is no large study to gauge the risk. And even Dr. Schenck says the vast majority of Ambien users should not worry, and to follow the warning labels provided with prescriptions.

SCHENCK: For people who are carefully diagnosed with insomnia or trouble falling asleep, Ambien is an excellent medication. And for most people, it is very safe and well tolerated.

GUPTA: The manufactures says if you find yourself sleepwalking after taking Ambien, see your doctor.

Dr. Sanjay Gupta, CNN, reporting.


ZAHN: Fascinating.

Coming up next in our "Out in the Open" special, "Food: The Secret Struggle," how a star of "The Sopranos" put her life in danger by overdoing something that's supposed to be good for all of us. Well, in her case, it almost killed her.


ZAHN: More now of our "Out in the Open" special, "Food: The Secret Struggle."

Just about all of us have felt some kind of pressure to shed the extra pounds from time to time in our life. Maybe all the time. But for celebrities, that pressure is beyond intense, and it could push them to do things that end up being life-threatening.

No young actress understands that better than Jamie-Lynn Sigler. She was just a teenager when she found herself starring in an Emmy- winning drama on HBO as the unforgettable Meadow Soprano.


JAMIE-LYNN SIGLER, ACTRESS, "SOPRANOS": Want to look out for ducks, Dad?

PAULA ZAHN, CNN CORRESPONDENT (voice-over): It would be the role of a lifetime for 16-year-old Jamie-Lynn Sigler, who started acting when she was seven and always dreamed of being a star. But behind the scenes, Jamie-Lynn was in a desperate fight for her life.

(on camera): How seriously did you consider suicide?

SIGLER: Pretty seriously.

ZAHN (voice-over): It was a shocking turnaround for this New York teen who seemed to have it all.

Jamie-Lynn succeeded at everything she did, until her first boyfriend, her first love, broke up with her in the fall of 1997.

SIGLER: You know, was I not good enough? Was I not pretty enough? Was I not skinny enough?

And it was at the time where a lot of my friends started talking about dieting, calories, exercise, something that was never discussed, never a concern of mine or any of us, and it ended up becoming an obsession. Within four months, I might probably dropped almost 40 pounds.

ZAHN (on camera): That is an amazing amount of weight.

SIGLER: Oh, yes.

ZAHN: What did you do?

SIGLER: It started off kind of pretty innocently, I guess, I can say, because I started, you know, maybe just doing, like, 20 minutes on the treadmill before school and then deciding I wasn't going have any dessert anymore.

And then, when I saw the scale start to go down, well, then, I thought, well, what happens now, if maybe I exercise an hour before school and don't eat bread? And that snowballed into exercising four and a half hours before school every morning and basically eating next to nothing.

ZAHN: What time were you getting up in the morning?

SIGLER: 3:00 a.m.

ZAHN (voice-over): Jamie-Lynn's eating disorder is called exercise bulimia. Exercise bulimics work out to purge what they have eaten in much the same way bulimics vomit after eating.

Chronic, obsessive exercise, accompanied by vigilant, nearly compulsive focus on calories. And Jamie-Lynn counted every last one, using a calculator to make sure she always burned every last calorie she consumed and more.

On some days that could be as few as 400. All it would take was the outside of a bagel, a fat-free yogurt, and a diet frozen dinner.

(on camera): What else would you eat the rest of the day?

SIGLER: Lots of diet soda. Lots of diet soda.

ZAHN: I don't count that as food. I count that as drink. SIGLER: I would constantly make excuses that I ate already, or I wasn't hungry, or I was rushing here or there.

ZAHN (voice-over): Jamie-Lynn kept on losing weight. She would exercise whenever and wherever she could. For extra exercise, fidgeting in school. When she had to do laundry, taking her laundry down to the basement one item at a time so she had to take extra trips.

SIGLER: I was completely physically and mentally addicted to the exercise and the restricting of calories. I was wearing, you know, basically children's clothes. I mean, I was a teenager and back to children's sizes.

It was hard to find clothes that would fit. And it was, like, every week I would see my reflection of my back and see more bones coming out, more ribs, and more hip bone. And it was awful.

UNIDENTIFIED MALE: Look at me. This is no joke.

ZAHN: During this low point in her life came what should have been a high point in her career. In November of 1997, HBO announced that "The Sopranos" was being picked up for five seasons.

It should have been a dream come true for Jamie-Lynn. But under the spell of her eating disorder, nothing else mattered.

SIGLER: I truly lost a will to live. I seriously contemplated suicide because I felt that no one in this world would ever understand the constant battle I had in my head every day.

ZAHN: Jamie-Lynn's rock-bottom moment came soon after, on a drive with her parents into New York to go rollerblading. Because they left the house more than 45 minutes late, Jamie-Lynn's strict exercise and eating schedule was completely disrupted, a disaster for an exercise bulimic.

SIGLER: I was shaking and crying in the back of the car. And my parents were crying, because they didn't know what to do. And it's where it just all became too much. And I blurted out, "I have an eating disorder. I want help."

And my parents pulled the car over in FDR. And I remember we hugged, and we cried. And the next day, I was, you know, with a therapist, nutritionist. I was on Prozac.

ZAHN: Jamie-Lynn cut down on the exercise, started eating more, and explored with the therapist the underlying causes of her eating disorder. The antidepressant Prozac, which is used to help treat a majority of eating disorders, helped Jamie-Lynn deal with the major mood swings associated with her bulimia.

In a few months, Jamie-Lynn gained five pounds. When it was time to go back to the set of "The Sopranos" in June of 1998, she was still 35 pounds thinner than when she had filmed the pilot less than a year before. (on camera): The producers brought your mother in a room. They were really concerned about the way you looked, and they weren't sure you were going have the stamina to do the job. Were you also aware that those same producers who were reasonably honest with your mother were conducting auditions behind the scenes to replace you?

SIGLER: I was filming the second episode. I mean, I was shocked, but almost empowered in a way, like I wasn't going lose it.

UNIDENTIFIED MALE: Dad, how do you stay so hip?

ZAHN (voice-over): It took more than eight months for Jamie-Lynn to get back to her normal weight. By the time she started shooting the second season of "The Sopranos" in June of 1999, she was healthier. Her transformation from season one to season two was dramatic. Everyone noticed.

SIGLER: Thought that people were going say, "Wow, she looks so healthy. She's not sick anymore. Good for her." And instead it was, "Wow, can you believe how fat she got?" And they went on from there.

And it was horrible. I was terrified of just now all of a sudden feeling like, well, what does this mean? In order to be accepted in this industry, do I have to have an eating disorder? But I'm so happy now. I don't want to go back there, but what do I do?

But fortunately, because of what I had been through, I wasn't afraid to talk about it.

ZAHN: So Jamie-Lynn came out about her eating disorder on an HBO fan web site and in a candid autobiography.

SIGLER: Once I did come out about it, I started getting letters and fan mail from young girls. And that's when I really realized how important it can be.

ZAHN: Today, Jamie-Lynn has stabilized herself at that healthy weight, by exercising moderately and eating normally, but she doesn't consider herself cured. Instead, she will always be recovering from the disease that almost cost her her life and her career.

(on camera): Is it true to this day, now that you're at a healthy weight, that you still carry with you in your purse a picture of yourself when you hit about 80 pounds?


ZAHN: Why do you carry that around? And what do you see?

SIGLER: It's awful. For me, the reason why I carry it with me is just because of a constant reminder of what I've been through. I thought that that was my life. I was set.

This was the way I was going to have to live my life. And knowing that I was able to overcome it and be healthy happy again is amazing. (END VIDEOTAPE)

ZAHN: I think Jamie-Lynn is amazing.

COHEN: So great.

ZAHN: Her story is so raw. I think she was so brave to share it. And then, of course, the irony is, as she explains to everybody that she had this eating disorder, she gets all this hate mail from people saying, "Why are you gaining so much weight?" I mean, she just couldn't win.

COHEN: That's terrible.

ZAHN: But she's really been triumphant. And good for her.

But you've got to wonder, there are a lot of people out there who probably exercise too much. What are the warning signs that you could be in trouble like Jamie-Lynn was?

COHEN: It can start innocently. We heard Jamie-Lynn say that it started with just 20 minutes, and then worked her way up to an hour.

ZAHN: And she's getting up at 3:00 in the morning and working out.

COHEN: Right. And eating less. And so it can start very innocently, but then it can get worse.

So, how do you know when you've crossed that line? Well, there are a couple of signs that you should look out for.

And the first sign is, if you're missing work or a party or something like that in order to exercise, that's a sign that's something's gone wrong.

Also, if you're exercising even when you're sick or you're injured, another sign that maybe you have started to cross that line.

If you become seriously depressed, if you can't exercise, of seriously upset -- you talked about that moment in the car where she couldn't exercise and she was crying -- that's a sign that things have gone too far.

And also, if you're not taking any rest days. You shouldn't be exercising heavily. Even athletes don't do that seven days a week, 365 days a year. If that's what you're doing, then you ought to think about seeking help.

ZAHN: Well, you've got to believe that her story has probably saved some lives, because she has been so open about her own struggle.

Elizabeth, stay with me.


ZAHN: You've got more work to do on this Friday night. Do come back.

COHEN: We do. We do.

ZAHN: Still ahead, treatments for eating disorders are always evolving. But wait until you hear what some doctors are using to help people desperate to lose weight.

We're going to bring that controversy "Out in the Open" next.


ZAHN: CNN Medical Correspondent Elizabeth Cohen is back with me now.

We've been using the number all night long. Some eight millions Americans suffering from some kind of eating disorder. And what we haven't had time to get to is the enormous cost of treating these disorders.

I wanted to put up on the screen now to give our audience an idea of what in-patient treatment costs -- $30,000 or more a month. Now, when you talk about outpatient treatment, including therapy and monitoring, that could add up to $100,000 or even more than that.

COHEN: Right, and who has that kind of money?

ZAHN: No one.

COHEN: Can you imagine, you've got an anorexic daughter, and you call up and you say, "How much is a month at this treatment center?" Thirty thousand dollars.

And the families I've talked to say, well, "I assumed my insurance would pay for that." But guess what? Insurance often only pays for a small portion of that. So parents are stuck with these gigantic bills.

It is a huge problem, because it becomes a vicious circle. This woman I interviewed who had weighed 80 pounds for years, she would get one month of treatment that was partially paid by insurance, partially her parents would pay for it, and that was it. And she wouldn't really get very far in one month.

And then she would have to wait a year for her insurance to kick in for another month. She's been doing this and still doing it year after year after year.

ZAHN: It's so sad.

COHEN: It is so sad. Insurance companies say, look, we can't spend money down a black hole.

None of these treatments have truly, truly been proven to work very well -- that's what the insurance companies argue -- so why should we be paying out hundreds of thousands of dollars for treatments that don't necessarily help these women? That's their argument.

ZAHN: We've been talking a lot tonight about people who can't seem to get enough calories in their bodies. There of course are people who are really fighting mightily to lose an awful lot of weight. And you have a controversial way of doing so that's "Out in the Open" tonight.

What is it?

COHEN: Right. This was amazing.

I visited with a doctor outside Chicago this week, and the story will be on next week. He is so upset about this obesity of childhood -- epidemic of childhood obesity, that he is giving kids amphetamines to help them lose weight.

It's called Adderall. You see it there. It's a drug used to treat ADD.

These kids don't have ADD. They're just overweight.

Well, the parents and the kids are very happy to be taking these amphetamines. Let's hear from one of these kids now.


COHEN: That must have been pretty surprising to have your appetite change like that.

UNIDENTIFIED MALE: Yes, and you should have saw everyone else when I went back to school that next year. I mean, everyone didn't believe it was me.


COHEN: Adderall -- that Adderall worked so well for that boy, he said his appetite was cut in half.

ZAHN: Unfortunately, it's something a lot of kids in college campuses are abusing.

COHEN: That's right. And adults, too.

ZAHN: Elizabeth, thanks. Glad to have you with us throughout the hour.

Now, if you're one of those millions of people secretly suffering from an eating disorder, here is a way to get some help.

Please contact the National Association of Anorexia Nervosa and Associated Disorders. They offer hotline counseling, a national network of free support groups, referrals to healthcare professionals, and more.

Send an e-mail to the address on your screen, or please call 847- 831-3438. We'll be right back.


ZAHN: Welcome back. Before we leave you tonight we're going to switch gears now. And we have a "BizBreak" for you from Kiran Chetry.


ZAHN: Thank you all for joining us. Hope you'll be back at the same time, same place, next week.

We'll be back here Monday night.

Have a great weekend, everybody.

Good night.


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