WASHINGTON — U.S. President Donald Trump is a commander in chief who fuels himself with a steady stream of Diet Cokes, scoops of vanilla ice cream and slabs of red meat. He gets as little as five hours of sleep a night. He is not known to exercise more than the brief strolls beyond his cart on the golf course.
This, he and his aides have maintained, is the very picture of presidential stamina.
On Friday, Trump, 71, will undergo his first comprehensive physical examination as president, and the first formal check on his former doctor’s Trumpian 2016 campaign claim that he’d be the “healthiest individual ever elected” to the office. But the first year of Trump’s presidency has triggered private scrutiny over his sedentary lifestyle — friends have noticed an increase in his girth — and a public debate over erratic behaviour that included the president’s recent tweet storm defending himself as a “very stable genius” after a book detailed his mercurial demeanour.
If the White House releases the same amount of information shared by other presidents, the public may soon learn more about how Trump’s lifestyle and fondness for fast food affects his health. It is less likely that the physical will yield in-depth insight into Trump’s psyche. A White House official said that Trump will not undergo a psychiatric exam, and would not say if he would undergo other forms of cognitive testing that may screen for mental disorders, including dementia.
A review of annual checkups of presidents dating back to Jimmy Carter shows that there is no template to follow and no set precedent for administering physicals or reading out results. Like any other medical patient — and other presidents — what Trump ultimately reveals to the public about his health will be up to him.
But Sarah Huckabee Sanders, the White House press secretary, said in an interview Tuesday that the White House physician would likely follow a process similar to what was followed for Presidents Barack Obama and George W. Bush. In those physicals, the White House provided specific information about height, weight and cholesterol. Bush’s physical noted that he smoked the occasional cigar. His physical also noted weight fluctuation likely attributed to increased muscle mass. President Bill Clinton’s weight was also noted as fluctuating during his presidency.
Historically, presidential checkups tend to buoy whatever image the candidate and president have presented about his health. For that reason, said Robert Dallek, a presidential historian, physicals should be of “probably zero” interest to the public.
“Did the White House always tell us what the doctors found?” Dallek said in an interview. “Are the doctors candid? If they found signs of early dementia, and they told him, would he tell the public?”
Trump’s physical is scheduled to take place at the Walter Reed National Military Medical Center in Bethesda, Maryland, with a post-physical readout to be given by Dr. Ronny L. Jackson, a rear admiral in the Navy and the current White House physician. Jackson has overseen the physicals of Obama and was part of the medical team involved in at least one of Bush’s physicals.
Jackson assumed care of the president when Trump entered office and has spent a “significant” amount of time with him over the past year, Sanders said. Jackson is also the physician from the White House medical unit who travels with Trump most often.
Because Trump is a commander in chief who is selective about releasing information about his personal life, questions have been raised about the reliability of the information he shares with the public. In the past, physicians examining presidents have mischaracterized or hidden illnesses to present them as healthier: Former President Franklin D. Roosevelt readily acknowledged his polio, for instance, but his White House doctor hid the severe high blood pressure that led to heart failure.
The Trump White House has not disclosed the names and specialties of the medical professionals who will be evaluating the president, as a number of his predecessors have. The responsibility of determining the types of medical tests needed and specialists included in the physical falls to Jackson.
Trump was observed to have slurred speech during a December speech acknowledging Jerusalem as Israel’s capital, but it is unclear if a neurologist or speech pathologist will be involved in the physical. (“The president’s throat was dry,” Sanders said at the time. “Nothing more than that.”)
As questions about Trump’s mental health have increased, psychiatrists are openly debating the so-called Goldwater rule. Generated in the wake of the erratic candidacy of Sen. Barry Goldwater, the 1964 Republican presidential nominee, the rule bars members of the American Psychiatric Association from evaluating anyone they have not personally examined.
Trump would still be expected to be screened for problems like unusual anxiety or stress: The physicians involved in the president’s care are trained to observe him as any other patient and ask questions for clues to such problems.
As he recently defended his mental acuity, Trump invoked the name of a predecessor who faced similar scrutiny while in office, though not to this degree.
In a tweet last weekend, Trump wrote: “I’ve had to put up with the Fake News from the first day I announced that I would be running for President. Now I have to put up with a Fake Book, written by a totally discredited author. Ronald Reagan had the same problem and handled it well. So will I!”
At 69, Ronald Reagan was the oldest person elected to the office — a record Trump surpassed in 2016 when he was elected at 70. Reagan, who, like Trump, had a family history of Alzheimer’s, said in an interview in 1980 before he took office that he would resign if deemed unfit. In 1994, nearly six years after leaving office, Reagan was diagnosed with Alzheimer’s, though there is no conclusive evidence he suffered from the disease while in office.
Whether or not Reagan showed signs of the disease in office — and if those symptoms affected his decision-making ability — has become a contentious issue of interest to historians and policymakers. Doctors are increasingly paying attention to screening for cognitive function in all older people.
Both Trump and his former Democratic opponent, Hillary Clinton, were urged to undergo baseline cognitive testing for comparative purposes if symptoms developed during their presidency. Neither candidate is known to have undergone brain scans or other related tests, which are considered useful but not definitive.
I’ve had to put up with the Fake News from the first day I announced that I would be running for President. Now I have to put up with a Fake Book, written by a totally discredited author. Ronald Reagan had the same problem and handled it well. So will I!— Donald J. Trump (@realDonaldTrump) January 7, 2018
Obama’s physicians noted his levels of prostate specific antigen, or PSA, a marker for prostate cancer. Dr. Harold N. Bornstein, Trump’s former personal physician, wrote in letters during the campaign that Trump’s PSA level was 0.15. Urologists not connected with Trump said they suspected that he had been treated for an enlarged prostate or prostate cancer.
Then Bornstein said in an interview with The Times in February 2017 that Trump takes a small dose of finasteride, a drug that is marketed as Propecia to treat male-pattern baldness and lowers PSA levels.
Trump played sports as a youth but appears to have dropped the habit as an adult. The consequences of Trump’s sedentary lifestyle may be reflected in the readout. Documented substantial weight gain may raise concerns about the state of his heart. Doctors may recommend an exercise tolerance test and other measures of heart function.
Trump is said to get little daily activity beyond walking the stairs in his residence and, on days when he has trips, strolling across the White House lawn to Marine One. At the group of Group of 7 summit meeting last May, Trump took a golf cart a short distance while other leaders walked.