Medical Mystery: Who’s snoring in the White House?

US NEWS WHITEHOUSE-DECORATIONS 15 ABA
The White House Christmas decorations are seen in the North Portico during a press preview on Nov. 29, 2016 in Washington, D.C.

William Howard Taft was our heaviest president, weighing in at 320 pounds when he took office in 1909, and as much as 340 pounds when he left four years later. In that era before the obesity epidemic, his size was extraordinary. One cartoon pictured the 6-foot president wedged into a White House bathtub, unable to get out. Wags called him the “walrus in wingtips”; his suits were said to be “like tarpaulins” straining at the buttons.

At 6 feet tall, his peak body mass index was 46, the greatest ever for a U.S. president.

Camera icon Credit: Library of Congress
President William H. Taft, 1857-1930.

Taft won the endorsement of his friend and longtime predecessor Teddy Roosevelt, whom Taft served as secretary of war. Both men were progressives, fiscal conservatives, lawyers, and believers in American exceptionalism. But although Taft was an active "trust-buster" early in his term, initiating 80 antitrust suits against large corporations, later he backed away from these efforts, disappointing Roosevelt.

White House staff worried when Taft would appear to fall asleep during meetings. Though some observed that he had occasional cognitive impairment, staffers continued official business, pretending not to notice that the commander in chief was dozing.

But his somnolence could not be kept secret. In public, he was seen to sleep in a car with its top down as it traversed New York's Fifth Avenue. He slept at the opera, at funerals, in church, and while playing cards. He fell asleep during conversations with the speaker of the house and with the chief justice of the United States.

Doctors knew that Taft's heart was giving out. Those around him saw him deteriorate physically and even mentally. He made so many errors in speaking that he was called "Taft the Blunderer" and "Mr. Malaprop.”

What caused the president’s daytime sleepiness and even snoring? Did he show signs of cognitive impairment while in office?


SOLUTION:

Medical journals have reported evidence that President Taft suffered from a condition that has become more common today as the obesity epidemic has continued: obstructive sleep apnea. In 1956, medical journals first described “Pickwickian syndrome” or “obesity hypoventilation syndrome” as characterized by excessive daytime sleepiness, snoring, severe obesity, hypertension and even cognitive and psychosocial impairment. The condition took its name from Charles Dickens' The Pickwick Papers, which features a character named Joe, noted for his size and sleepiness.

Today, patients are often prescribed weight loss (as Taft was), along with use of a CPAP (continuous positive airway pressure) machine to prevent apnea (which was not available to Taft).

Taft’s sleepiness was severe and obvious, but never prompted official discussion of his fitness to govern. His hypertension also worsened: In 1910, doctors found that Taft's systolic blood pressure was 210, well above top normal range of 120 to 140. By December 1911, an aide noticed that “he pants for breath at every step.”

Some say that losing his bid for reelection to Woodrow Wilson in 1912 may have saved the 55-year-old Taft’s life. After leaving the presidency, Taft went on a physician’s strict diet, avoiding fatty meats and eating mainly fish and vegetables.

His success was highlighted in the New York Times on Dec. 12, 1913. “On the Fourth of March … I weighed exactly 340 pounds. … "This morning … I tipped the scale at exactly 270.8 pounds," Taft told a reporter. "I have lost exactly 69.2 pounds of flesh.”

His weight was fairly stable for the rest of his life. His decade-long daytime sleepiness and his sleep apnea — yes, he was a champion snorer in the White House — were resolved. His blood pressure improved, but lasting heart damage developed in the form of atrial fibrillation.

In 1921, Taft was appointed chief justice of the United States by President Warren Harding. In the summer of 1929 he admitted he was too sick to keep up with his work load.

"I am older and slower and less acute and more confused,” he told his brother in late 1929. A stroke was suspected with heart failure, hypertension, and atrial fibrillation. Digitalis, one of the few medications then available for heart disease, was prescribed. Taft resigned from the Supreme Court on Feb. 3, 1930, and died March 8, 1930 at age 72, weighing 280 pounds.

Allan B. Schwartz, M.D., is a professor of medicine in the Division of Nephrology & Hypertension at Drexel University College of Medicine.