Author and screenwriter Peter Hedges saw a tape of Cates on a 1992 episode of Sally entitled "Too Heavy to Leave Their House".

[2] Hedges offered her the role of a morbidly obese mother in the 1993 film What's Eating Gilbert Grape, which she accepted.

Her performance, her first attempt at acting in any form, received critical acclaim and was lauded by her costars Leonardo DiCaprio[4] and Johnny Depp.

After finishing her 1992 diploma, Cates ended her five year period of reclusion, accepting an invitation to appear on the Sally show - an offer that came through her support group.

[8] In 2012, Cates had lost 240 pounds (110 kg) after a series of health issues in 2010 kept her hospitalized for nearly a year, and she expressed a desire to resume her acting career.

[12][13] Leonardo DiCaprio, who portrayed her son in 1993's What's Eating Gilbert Grape, posted a tribute to Facebook, stating Cates was "the best acting mom [he] ever had the privilege of working alongside.