equire lots of extras. tonight, we do to a hospital that takes extraordinary measures to cater to super sized patients. but at what cost to the health care system? plus, just cher. for five decades, she's been a star, an actress and an icon. tonight, cher talks about her new film. her life's many roles. and coming to terms with her daughter's decision to become a man. and, tragic eptdnd. after a 13-year-old girl was found tied up in an ohio

basement last week authorities have been searching for the rest of her family. today, the grim discovery. we have the latest. >> announcer: from the global resources of abc news with terry moran, cynthia mcfadden and bill weir in new york city this is "nightline," november 18th, 2010. >> good evening. we begin tonight with america's obesity epidemic. a study released last month by the national bureau of economic research found that obesity-related medical expenses costs the united states $168 billion a year. nearly 17% of total medical costs. where does the money go? well, tonight, we visit an alabama hospital especially outfitted to accommodate extreme little overweight parents. john donvan has our report. >> reporter: in one of the largest hospital centers in the

nation, size matters. just not in the way anybody really wants it to. the size of obese patients who, by their sheer weight and dimension, when they get here challenge the system from the teams that handle emergency case s -- >> it takes more of our people to help move the patients if they are not able to move themselves. >> just to do any invasive procedure we need help. >> reporter: to doctors who need to get breathing tubes into in this case, an obese trauma victim. >> makes it difficult for us to try to find -- more difficult for us to find their airway. >> reporter: because there's so much fat in the way? >> that's right. >> reporter: or even to close a wound. >> if he were a thinner person, probably would have been able to do it all in one operation. because he is a larger person that made us want to operate more than one time. >> reporter: and even in the maternity floor, to og-gyns, who have to adapt to moms of a

certain size. >> we have special instruments. when they require a caesarean section, deciding where to make that incision is more problematic. >> reporter: we are at the uab hospital that's university of alabama at birmingham. certainly among the nation's most modern medical comet plexes, but it is dealing with a weight problem. it's the patients. also, a good number of the hospital staffite. it is, to be blunt, the neighborhood that uab is in. >> how often do the bigger patients come in? >> regularly. >> being in alabama, regularly. >> reporter: hospital ceo michael walldrum calls it the obesity belt and alabama is part of it. >> being in the middle of the obesity belt for the country, and living through this epidemic, we have a need to provide more services so, just -- >> reporter: because you have more obese patients. >> more patients. >> reporter: like diane warren who gave birth to arianna a few

days ago. it wasn't a few days ago. at this point, it had been six days? >> reporter: that's long to stay compared to most women. is that again related to your size? >> we had to take extra precautions with me and everything they did. >> reporter: debra was diane's doctor. >> we were concerned she was developing pree clamp see ya. >> reporter: is which? >> blood pressure becomes elevated and it's a candidate that if left unchecked can cause liver dysfunction, kidney dysfunction, seizures. >> reporter: what does that have to do with her weight? >> obese women are at increased risk. in addition, diane has a history of underlying chronic hyper tension or high blood pressure. >> reporter: again related to her weight? >> most likely related to her weight, yes. >> i mean you want to hear -- pregnancy is going to be like everybody elses and you're going to have a healthy baby. >> reporter: what were you told? >> i could get pree clamp see

ya, which i did. she could be stillborn. i might not make it through the c-section if i had to have one. she might not make it. >> reporter: these are all con consequences of your size? >> right. and high blood pressure. i have a thyroid problem. everything all mixed together. being the size that i am it -- everything contributed to it. >> reporter: how much of the warnings came true? >> i had the high blood pressure. but we're here. >> reporter: so, it is longer stays, but it is a bigger team needed to assist with the delivery. >> when patients are in labor, they have an epidural they can't assist in movement in the same way so it takes an increased. >> reporter: how many people, four, five? >> we had four surgeons in diane's surgery, three anesthesiologists, two scrub techs, you know -- >> reporter: it took all of you to move her? >> it took about six to eight people to get her moved.

>> reporter: but let's be clear, at uab, that honest description of the facts is not intended as a criticism of the patients. if anything, uab's gone out of its way to make the obese feel comfortable here. investing in oversized beds designing rooms with plus-size doorways and this wheelchair extra large. which may not be so obvious until i roll up a standard-sized chair for comparison. >> the equipment in those rooms, the beds for instance compared to the beds we own, we have to rent beds -- >> reporter: what does that cost you? >> 50% more per bed. >> reporter: but they're the sort of adaptations that make misty and joe, who are expecting in 14 weeks, feel much more comfortable coming here for her premayal care than where she used to go. >> the facility that i had chose to use originally they were really devastating to me. >> reporter: in what way? >> they didn't have high prospects for her because of her weight. >> reporter: to get pregnant or to have a healthy -- >> to have a healthy pregnancy.

>> to carry a baby at all or anything. >> reporter: well, it sounds as though her previous clinic was only telling her the truth, because obesity does raise the risks, but uab doesn't deal in stigma or shame. even while requiring extra sonograms, a chance for babies to hear their heartbeat, which isn't always possible when players of fat muffle the sound. it's not that patients here are never told they should lose weight, in fact, weight modification is dr. jamie art's specialty. >> how is the exercise going at home? >> slowly. >> reporter: but like many here he is careful not to make it about shame. >> the goal is to lose the weight. >> reporter: a lot of people, unfortunately, avoid medical care because of their weight. they've had a bad encounter with a physician or health care provider who didn't understand some of the challenges that they were going through. so rather than deal with that embarrassment, they just skip

the screening tests that would have prevented some poor outcome down the road. >> reporter: and so they do come and they do get care in a place where, yes size matters, but just not in quite the same way in here as it does on the outside. i'm john donvan for "nightline" in birmingham, alabama. >> acknowledging and trying to deal with a complex problem. when we come back from "i got you babe" to "if i could turn back time." cher has been a box office star for five decades. tonight, our exclusive interview. hi, we're looking to save some money on our car insurance. great! at progressive, you can compare rates side by side so you get the same coverage often for less. wow! that is huge! [ disco playing ] and this is to remind you

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well, we turn now to entertainment. before there was gaga before there was madonna, there was cher. she endures. she's had a hit record in every one of the past five decades. and has sold 100 million albums

along the way. now, at age 64 she's starring in a new film. and agreed to sit down and talk about any and everything including her daughter's painful decision to become a man. ♪ show a little more ♪ >> reporter: this is cher. 64 years in the making. the film "burlesque," her first starring role in a decade. ♪ welcome to burlesque ♪ >> it was hard work. it was the hardest work i ever did on a film. 16-hour days. >> reporter: her co-star is christinaing a lair ya in her film debut. how talented is she? >> very talented. she has a really good shot. but you know she was not very trusting of me. and i said too her, i will not

do any [ bleep ] actress stuff. if you know what you're doing, you can screw around with someone, and i said i'm here to support you and i always will so let's just start there. if you fall off the stage leg extended, boobs out. >> reporter: cher plays tess. the role is pure cher. >> tell me what you're looking for. >> i'm looking for someone who can do the routine. you have to make me believe that you belong up there. you want to show me something, show me that. >> reporter: she's tough on the outside and sort of -- >> well, she's tough all the way through, but she's, you know, no one's tough all the time. >> reporter: so, how much like you is she? >> i think she's quite a lot. >> reporter: no one could have survived as long as as lively as cher without being taught. and the two have something else in common. >> yes, ma'am. >> and don't ever call me ma'am again. ma'am. what am i, my mother?

>> reporter: does anybody in real life call you ma'am? >> nope. people call me ma'am, i just go no, i'm cher. i'm not miss cher not ma'am, just cher. >> reporter: that seems to be plenty good enough. even when she's acting with people less than half her age. >> the girls were mesmerized by the fact i was my age. could not believe it. could not compute it. when you're 29 and your co-star is 64 -- >> reporter: you're keeping up with them. >> i said to them this is what i need you to do. >> reporter: and it did. though, she's no fan of getting older. >> i would love to be like those women who are just so happy with their age and, you know just feeling that they've never been better and all that and, but i just don't believe it. you know? i just -- for me it's just -- old age gets in my way. >> reporter: she says her pal meryl streep who she co-starred with in "silk wood" 27 years ago, is an exception.

>> yeah, she's aging beautifully and doesn't care about it and, you know, pissed me off. >> reporter: she admired the vastly different roles streep has played. we asked, could she play them? >> this is my fault, i'm sure this is my fault. i haven't stretched myself you know? i play comfortable things that i know, that i feel. but i mean there are things that actresses do so that people know that they've got something more than just that. >> reporter: tess is close to you. >> tess is real close. ♪ if i could turn back time ♪ >> reporter: she has perfected the role of cher. remember the eye-popping number she wore 20 years ago when she sang "if i could turn back time"? well, she showed up at the vma awards in it this year. like it or not, the matriarch of the scantily clad. >> so, so far i'm the oldest

chick with the biggest hair and the littlest costume. >> reporter: it was a delicious moment when cher presented an award to the lady of the moment who was wearing, well a dress made of meat. >> i never thought i'd be asking cher to hold my meat purse. >> i was watching the way the cuts of meat were sown together and i thought, this is a beautifully tailored outfit. >> reporter: i have to know did it smell funny? >> no. i was so surprised. i thought, they must have done something to this. >> reporter: there is some cher in lady gaga don't you think? >> i think that yeah because anybody who is going to goballs to the wall -- i did it in my time which seems so simple and innocent now. but we're artists. we're supposed to make people think. >> reporter: let me ask you about a few people. the kardashians. >> what i know about them you can put it on a head of a pin and still have room for the

lord's prayer. i know nothing about them. >> reporter: you don't watch that show? >> no. i don't like reality shows at all. >> reporter: so snooki you have seen her? >> is she the girl -- i got a bobblehead in some like you know, the packaging that they give you when you two some place, so, there was a bobblehead of her. not too impressive. i kind of like people that do something. that are not just famous for -- i'm not sure what. >> cher is of course for famous than more than just her talent, and when we come back she talks about her daughter's painful decision to have gender reassignment surgery. okay, now here's our holiday gift list. aww, not the mall. well, i'll do the shopping... if you do the shipping. shipping's a hassle. i'll go to the mall. hey.

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announcer: "nightline" continues from new york city with cynthia mcfadden. >> we continue now with cher who says at age 64 she just doesn't see anything good about getting older. though she has learned a lot along the way. when she started out, her then-husband sonny bono owned 95% of their company. the lawyer owned the other five. so, is she now one of the richest women in show business and is she upset with her daughter for deciding to undergo gender reassignment surgery? here's cher on cher. cher's cost-star, christina ag lair ya, wasn't even born by the time cher had a slew of hit

singles beginning with "i got you babe" in 1965. ♪ i got you babe ♪ >> reporter: in 1973, it was "half breed." christina was 6 when cher recorded this one. "i found someone." ♪ i found someone ♪ >> reporter: you get to your stage, where you're clearly, you know, the one-name icon and everyone thinks, oh it has always been swell. >> well, that's not true. i mean there have been really lean times. times where i was kind of a joke. and that's really hard you know? it's really hard to be a joke in your business. and everything in my business is about being cool and about appearances. very little in my business has to do with reality. ♪ i still haven't found what i'm looking for ♪ >> reporter: but a lot has to do

with fantasy. in february, her vegas show ends, where she reportedly grossed $60 million. every indication you are one of the wealthiest entertain earnsearn srs -- >> that's not true. am i hurting? not at all. but i'm not one of the wealthiest ones. >> reporter: the net worth is estimated over $600 million. >> oh from your mouth to gold's ears. no. it doesn't even resemble anything like that. i'm fine. i'm doing fine. but it's just not that. you know uncle sam sits on its ass and takes half of it. and then you have you know i have a big overhead an all that. i came from a place where i had to wrap my shoes with rubber bands to keep the soles on. i know how to appreciate it. >> reporter: there has been a lot to appreciate. the oscar for her role in "moon struck." >> i'm in love with you.

>> snap out of it! ♪ >> reporter: the grammy for "believe." it won every kind of award. how would you do on the motherhood award. have you been a good mother? >> no i've been a good mother in fits and starts. but when you do work like mine and i'm not sure it's unlike most working mothers, they never feel like they're doing a good job, because they're never able to devote the amount of time. and i have many regrets about my parenting. >> reporter: she has certainly worried about her daughter over the years. well, she was america's little girl for a long time. >> and that was hard for her, too. >> reporter: i read something that i think chaz said that you were just cher all the time and couldn't you sometimes not be cher? >> right. that was hard. i remember on a field trip all

these people kind of mobbed me and she went this is such a pain in the ass, no matter where we go you're just cher. and it's not something i can help so much. so, you pay the price. >> reporter: last year she told her mother and the world that she was getting gender reassignment surgery. she was becoming he. so, when chaz told you that he wanted to have gender reassignment surgery and go for it -- >> well, we talked about it before, over the years. so, and i said you know if you need to do this you better do it. she made the right choice for her. it the right choice and it's one life the only life and if he was so unhappy, you know you have to, you know make the decision to go for it. ♪ this is far from over ♪ ♪ you haven't seen the last of me ♪ >> reporter: you haven't seen

the last of me cher's solo in the film could be an anthem for her. ♪ this is not the end ♪ ♪ i'm down now ♪ ♪ but i'll be standing tall again ♪ ♪ times are hard but ♪ ♪ but i was built tough ♪ ♪ i'm going to show you all what i'm made of ♪ >> reporter: you've said that singers didn't take you seriously as a singer actors didn't take you seriously as an actor. >> and look what i've been able to still do. you know? some how i crept through. ♪ it's not the end ♪ ♪ you haven't seen the last of me ♪ ♪ you haven't seen the last of me ♪ >> no doubt about that. always fun to be with cher. the film opens in theaters nationwide on thanksgiving day.

we'll be right back. but first, here's jimmy kimmel. >> jimmy: tonight, robin quivers is here. author bill carter is with us. he has a new book about late night tv. we have music from my chemical romance and "this week in unnecessary censorship." "jimmy kimmel live" is next.

money. $200 bucks? that's not saving! [jacks voice] at my place i'm bringing back the bonus jack. two patties, melting cheese and my secret sauce plus fries and a drink for only $3.99. i get it. you can eat lo cheaper atouar placth y c]caat hom but do have this? i have dessert. what about this? ohhh. ohhhhhh. jack. that's for max.