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Paul Prudhomme: The Perils of Morbid Obesity

Paul Prudhomme died Thursday, October 8, 2015, at age 75. He was an internationally famous chef and restaurateur who, in the early 1980's, used blackening and spicing of fish and chicken in the Cajun and Creole traditions to build a food empire. He started a cooking craze that spread worldwide through his restaurants, spice products, television appearances and books. His broad smile, wrap-around beard and fast movements at the stove made people love Cajun cuisine and not notice that his lifelong obesity meant that he was indeed a very sick man.

Some news reports say that he died of natural causes following a brief illness, but that is unlikely. He was morbidly obese, and there is no such thing as a safe and healthy obesity. He once told reporters, "I've had a weight problem since I was eight years old. The last time I can remember being thin was at a photography session when I was four years old." As a teenager he weighed more than 500 pounds.

Worse than just being obese, he went on frequent extreme diets, and yo-yo dieting causes multiple health problems. His weight varied throughout his lifetime between 200 and 600 pounds. In a 2000 interview, he told reporters that he had just lost 130 pounds, weighed 360 pounds and was now more mobile in the kitchen. He also claimed that his cholesterol, blood pressure and other vital statistics were now well within normal range, which is hard to believe. In a 2013 cooking demonstration in New Orleans, he looked up from his motorized scooter and told the crowd that he had dropped his weight from 580 to his present 200 pounds. He claimed to have fasted once for 40 days. A 5'6" man who weighs 200 pounds is still obese and at high risk for diabetes, heart attacks and premature death.

He confessed that sweets were his major problem. In one article he said, "I was always a binger, I would refrain, then buy a quart of ice cream and eat the whole thing. ... but I can't eat sweets every day or I'd weigh 1,000 pounds." He hired a special cook to prepare low-calorie meals for him and stuck to them almost exclusively for about a year. After he lost 100 pounds, he started eating two diet meals a day and one meal off the diet. His wife Kay said, "When Paul decides he's going to diet, there's nothing that keeps him from it--except no food at all." At various times he tried fasting, intermittent fasting, powdered diet products and a macrobiotic diet of whole grains and high fiber vegetables. He tried avoiding the sugar and the fat (butter, cream and eggs) that he used in abundance when he demonstrated his recipes on television.

His weight cost him dearly. He could not fit into a normal chair, had painful knees that originally forced him to use a cane and eventually made it so he could get around only on a scooter. He told reporters, "I'm mobile. I work 18 hours a day. I wake up every morning feeling wonderful."

Early Life and Success
He was the youngest of 13 children, raised by poor sharecropper parents on a farm near Opelousas, Louisiana. He spent much of his early childhood in the kitchen with his mother, who taught him "Cooking is about blending taste so things are worth eating." She made heavily-seasoned fresh vegetables, poultry and seafood. When Paul was nine years old, he learned that a cousin made an incredible $150 a week cooking in a New Orleans hotel, so he decided to become a cook.

In 1957, at age 17, he married and opened his first restaurant, a hamburger joint called Big Daddy O's Patio. After nine months, he divorced, lost his restaurant, and tried selling magazines for a living. He failed at that, spent a short time in New Orleans and then traveled the country cooking in bars, diners, resorts and hotel restaurants. In his late 20's, he returned to New Orleans to work as a chef in hotel restaurants. In 1975, at age 35, he took a job as head chef at the Commander's Palace restaurant, and the rest is history. He introduced Cajun and Creole dishes, such as chicken and andouille gumbo, that took over New Orleans and eventually swept through restaurants around the world.

In his early 30's, he met and married his second wife, Kay, a waitress who worked with him at the Maison Dupuy. Together they opened K-Paul's in the French Quarter in 1979. The restaurant
• had plywood walls,
• served the food on Formica tables,
• served drinks in jars,
• had only 64 seats,
• rented for $50 a month,
• had no freezers,
• advertised that it served only fresh foods,
• did not accept credit cards, and
• charged only $5 for dinner.
It soon became the most popular restaurant in New Orleans. They accepted no reservations and the lines always went around the block. They usually had five seatings each evening. He was featured on TV shows and national magazines and started producing his series of best-selling books. He explained to Craig Claiborne, the food editor of The New York Times, "Cajun cooking is old French cooking that was transformed into a Southern style when my ancestors migrated to Louisiana... It is spicier with pepper than authentic French, but when chefs come to this country from France, they say, 'That’s how my grandmother used to cook.'" Many of North America's top restaurants followed suit by replacing European menus with fish, chicken or meat covered with spices and blackened in a pan.

In 1983, he created a food company, Magic Seasoning Blends, to sell his dry spices, rubs, sauces and marinades. They are sold in more than 30 countries and have a huge factory in Elmwood, Louisiana. In 1993, his wife Kay died of lung cancer. In 2010 he married his third wife, Lori, and she survives him.

Morbid Obesity
You may want to tell me that he had 75 good years, but he didn't. He was terribly incapacitated for the last 30 or more years of his life. I have never examined Paul Prudhomme or seen any of his medical records, but I think that it is incredible that he lived as long as 75 years. I remember doing television shows with him in the 1980s and he was already using a motor scooter to move around. At age 40, he couldn't even get around with a cane. Excess weight causes osteoarthritis, and his knees were so damaged that he had severe pain and difficulty moving. Overweight men are five times more likely to suffer knee arthritis than those with normal weight (Am. J. Epidemiol, 1988;128:179-189). Being overweight turns on your immunity to cause inflammation (Cur Opin Rheumatol, 2010 Sep; 22(5): 533–537) that can damage all the joints in your body including your hands and wrists (J. Rheumatol, 1996;23:1221-1226).

It was certainly not his fault that he was obese. Morbid obesity is a disease that causes the same death rate as smoking, usually from cancer, heart disease or diabetes (PLOS Medicine. July 8, 2014;11(7)). People who weigh more than 300 pounds are different from those who are just a little overweight. Almost none can lose weight and keep it off permanently without surgery. A study followed 176,000 adults and showed that obese men have a 1-in-210 chance of dropping to a normal weight, and more than three-quarters of those who lost weight gained it back within five years (American Journal of Public Health, July 16, 2015). At this time, the only effective long-term treatment we have for morbid obesity is gastric bypass surgery (Cochrane Database Syst Rev. Aug 8, 2014), and the surgery has its own risks. Current research suggests that extremely heavy people have obesity-causing bacteria in their colons, but we do not yet know how to change the bacteria permanently. Perhaps in the future we will be able to prevent or treat morbid obesity by changing colon bacteria.

Why Being Even a Little Overweight Can Cause Diabetes, Heart Attacks and Death
A high rise in blood sugar damages every cell in your body. It causes dementia, impotency, nerve damage, blindness, deafness, joint pains, and lots more. Your liver protects you from having high blood sugar levels. When blood sugar levels rise after you eat, your pancreas releases insulin that drives the sugar from your bloodstream into your liver. When you store fat in your belly, you also store fat in your liver. Excess fat in your liver prevents the liver from accepting sugar from the bloodstream and blood sugar levels rise even higher. This high rise in blood sugar increases risk for heart attacks, strokes, certain cancers and premature death.

What Doctors Should Tell Their Morbidly Obese Patients
All people who are massively overweight should be told that it is not their fault. They are different and cannot be treated effectively with ordinary low-calorie diets. They should be evaluated by physicians who understand their problem and not be misled by fad diets, pills or other deceptions. Almost all will eventually require:
• gastric bypass surgery
• a lifelong eating pattern of intermittent fasting (International Journal of Obesity, December 26, 2014)
• evaluation to determine how much exercise they can tolerate, and participation in a supervised exercise program (inactivity itself can kill)
• medication as needed to control their associated inflammation, high blood pressure, high cholesterol or diabetes
• an understanding physician who will treat their disease and avoid blaming the victim.

Paul Prudhomme
July 13, 1940 - October 8, 2015

October 18th, 2015
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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