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Time takes its toll on presidents

President Barack Obama delivers remarks at an October campaign event at Sloan’s Lake Park in Denver. Doctors say the stress of the presidency is reflected on presidents' faces after their first terms. Illustrates INAUG-AGING (category l), by Ned Martel (c) 2013, The Washington Post. Moved Thursday, Jan.17, 2013. (MUST CREDIT: Washington Post photo by Marvin Joseph)
The Washington Post | The Washington Post

WASHINGTON — Time roughs up presidents. Photos of Barack Obama on election night in 2008 look like they were taken much longer than four years ago. Now his face has deeper creases and crow’s feet, while his hair is salted with white.

“You look at the picture when they’re inaugurated, and four years later, they’re visibly older,” said Connie Mariano, a former White House physician whose stethoscope checked presidential hearts from 1992 to 2001. “It’s like they went in a time machine and fast-forwarded eight years in the span of four years.”

That’s because of the unabated, unfathomable stress that presidents face. “You see it over a term,” said Ronan Factora, a physician specializing in geriatric medicine at the Cleveland Clinic. “It’s a good study of chronic stress on a person’s overall health.”



Changes in skin or hair are gradual, he said. “If you do have a stressful event, nothing is going to happen right away.” Nothing visible, anyway.

Inside the body, the pituitary gland jolts the adrenal gland, just above the kidneys. Hormones start coursing. Adrenaline cranks up the heart rate and blood pressure. Cortisol, another hormone from the same gland, causes inflammation and preps the body for converting sugars into energy.




“It’s not intended that people would be chronically exposed to these levels,” said Sherita Golden, a physician at the Johns Hopkins Bloomberg School of Public Health.

Cortisol strains the circulatory system, battering artery walls. The hormone also thins the skin and makes muscles and bones lose mass. The immune system weakens, and viruses that cause colds and cold sores take hold. Sleep turns fitful.

“Your cognition slows, you may feel more depressed, your ability to concentrate goes down,” Factora said. “And it just builds on itself — a real cascade.”

There is one known treatment for stress: exercise. “It is the best benefit a physician can recommend,” Factora said. “There is no drug that can present as many benefits as exercise can.”

Obama is a fiend for exercise. In hour-long workouts, he has been known to hit treadmills hard, weight-train with arms and legs, and build quickness through “plyos,” or plyometrics — exercises that involve explosive movements. He also throws footballs, shoots basketballs and thwacks at golf balls.

His predecessors exercised, too, some of them fiercely. George W. Bush ran till his aging knees made cycling a better option. Presidents Jimmy Carter and Bill Clinton jogged, while Ronald Reagan rode horses and split logs with such vigor, he once cut his thigh. President Gerald Ford performed a daily exercise regimen in his robe and PJs.

President George H.W. Bush “didn’t just work out, he worked out vigorously,” said his physician Burton Lee, citing four-mile runs and ball games with Marines at Camp David. Once he even played tennis with Pete Sampras.

“He broke the StairMaster at Camp David; he pounded it till it didn’t work,” Lee recalled. “If I’m on it for five minutes, you have to take me out on a stretcher.”

Good exercise leads to better thinking, brain mapping has shown. “Exercise actually brings more blood flow,” explained Linda Fried, an epidemiologist and geriatrician at Columbia University. “Parts of the brain are activated, and they’re associated with complex thinking and problem-solving.”

Workouts also force a president to – truly, finally, deeply – rest. Only then can the relaxed brain start to make creative associations.

Obama had a fitness test on Jan. 12, and the White House said the results would be released by February. His previous physical was in October 2011; it showed that he had added one pound since his February 2010 physical (his 2011 weight: 181, very good for a man who was then 50 and 6-foot-1).

Like all presidents since 1992, he is under constant medical watch: A military physician is on hand wherever a president goes, day or night. That firsthand observation started with Mariano, and even with all her access, she recalled how difficult it was to determine on many occasions whether Clinton was just super-stressed or full-on infirm.

“We were worried about Clinton when he was being impeached,” she recalled. “He looked like he had it all together, but we worried.” When she and her colleagues asked, all he would say was, “I’m tired.”


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