The Heart of Power – Episode 1: When Metabolic Disease Entered the Oval Office

“It took four men to pull the president from the bathtub.”

The newspapers had a field day. But did it really happen? The oft-repeated tale of President William Howard Taft becoming stuck in a bathtub is more legend than confirmed fact. There’s no definitive newspaper story from the time confirming the event. Most likely, the myth evolved from the truth that Taft had an extra-large tub custom-built for the White House—a detail that ballooned into political folklore.

The story seized the public’s imagination and forever altered how he was perceived. Cartoonists and critics turned Taft’s body into a symbol of excess and inertia. For political opponents, it was convenient satire. But for Taft, it was a private burden—and a public misunderstanding of a serious medical condition we now recognize as morbid obesity (Class III obesity).

The Heart of Power: Medical Histories from the White House.

This isn’t a punchline. It’s the beginning of a deeper story.

This is the opening chapter in a series of medical histories exploring the hidden health struggles of U.S. presidents. Behind the speeches and ceremonies lie stories of chronic illness, silent symptoms, and missed diagnoses. We begin with William Howard Taft—the 27th president of the United States, who served from 1909 to 1913. A brilliant legal mind and dedicated public servant, Taft remains the only American to lead both the executive and judicial branches. Yet behind that distinction was a man waging a quiet war against his own metabolism.

Taft’s Growing Shadow

Picture this: It’s a winter day at the White House. The halls still carry the faint echoes of a busy morning—the clink of teacups, the soft shuffle of aides moving from one meeting to the next. In the Oval Office, President Taft lowers himself into the oversized chair behind the Resolute Desk. His morning briefing folder lies unopened. He’s trying to stay alert, but his eyelids betray him—heavy, uncooperative. His breath comes shallow. The warmth of the room lulls him into a haze. He jolts upright with a grunt, glances around, embarrassed. This isn’t the first time.

Earlier that day, the band had played and the crowds had cheered—perhaps at a diplomatic reception or ceremonial speech on the South Lawn. But what lingered for Taft wasn’t the applause. It was the exertion: the breathlessness from the stairs, the weight of his frame pressing against the confines of his suit. His aides shuffle in with memos. He waves them off. “Later,” he says, massaging his forehead. The day is far from over, and already he’s exhausted

By the time he entered office, Taft weighed over 330 pounds (150 kg). But his physical presence wasn’t just imposing—it was symptomatic. Today, we’d recognize what he was living with: metabolic dysfunction.

He was chronically fatigued. He snored thunderously and sometimes nodded off during cabinet meetings. Hotel staff reported his loud snoring. His aides noticed him gasping for breath after short walks. These are now textbook signs of obstructive sleep apnea, a condition that dramatically increases cardiovascular risk—yet had no name at the time.

Taft also struggled with post-meal discomfort, bloating, and occasional chest pressure. Back then, these episodes were brushed off as heartburn. Today, we’d be concerned about coronary artery disease.

Taken together, these signs point toward metabolic syndrome—a cluster of dangerous conditions including abdominal obesity, high blood pressure, insulin resistance, and abnormal lipids. In the early 1900s, no one had the tools to connect the dots.

The Weight Wars

Taft wasn’t oblivious to his weight—far from it. He fought it like a man boxed into a losing battle. No modern labs, no metabolic panels. Just a bathroom scale, a pencil, and sheer determination.

In an era before obesity was classified as a disease, Taft treated it as his personal failing. But he also tried everything. And unlike many public figures, he documented his struggle meticulously.

He kept a daily weight log and mailed it across the Atlantic to Dr. Nathaniel Yorke-Davies, a British physician specializing in dietetics. Yorke-Davies responded with detailed, personalized plans: lean meats, limited fish, fresh vegetables, plain salads—no sugar, minimal starch. Their correspondence reads like the journal of a man both hopeful and haunted.

“This morning I weighed 314. I hope next week to show 313.”
“I do not mind telling you that I am as hungry as a bear almost all the time, but I try to keep the faith.”
“The truth is that I do not eat much, but I do not lose. I am discouraged.”

Between December 1905 and April 1906, Taft lost 59 pounds. “I feel in excellent condition,” he wrote to Yorke-Davies, and for a time, he did. It was an extraordinary effort, especially at a time when structured dieting and metabolic science were virtually nonexistent.

However, the greater challenge wasn’t weight loss—it was long-term weight maintenance, the battle he never stopped fighting.

Despite continued efforts and adherence to Yorke-Davies’ guidance, Taft regained the weight. What we now know is that metabolic adaptation, insulin resistance, and hormonal signaling all conspire to make long-term weight loss brutally difficult. The science of set points and energy balance hadn’t even been conceived.

“I walk and swing my arms and watch my food and drink, and yet the results are painfully slow,” he wrote. You can almost hear the breathlessness in his pen strokes.

There was no metabolic insight in 1909. No GLP-1s. No dietitians, no apps, no empathy. When the weight returned, it was seen as weakness.

But Taft kept trying. As Chief Justice later in life, he would order new suits every few years—not out of vanity, but because the body he lived in was never still. It was expanding, shrinking, recalibrating—a lifelong experiment without results.

And the doctors of the day? Their notes painted a stark picture:

• 1899 (Army examiner): “The abdominal wall is very fat and pendulous… general arteriosclerosis is evident.”

• 1908 (Navy physician): “Mr. Tuft is of such size and girth that it would not be surprising if his heart gives way under the strain.”

• White House aide: “A walk around the South Lawn leaves him flushed and breathless.”

The cartoons were harsher. One depicted him perched atop a scale labeled “Responsibility,” sweat pouring down his face. The caption read: “More Than One Man Can Carry?”

But they didn’t see what we can see now:

Behind the ridicule was a patient struggling with a misunderstood disease.

Therapeutic Options Today: A Different Battlefield

Had Taft lived in our era, his story might have unfolded quite differently. Modern medicine doesn’t just offer more tools—it offers more understanding. We now know that obesity is not a moral failing. It is a complex, relapsing, and often progressive disease influenced by genetics, hormones, neurobiology, environment, and behavior.

Pharmacological therapies have changed the game:

• GLP-1 receptor agonists (e.g., semaglutide, liraglutide), approved in the early 2010s, mimic gut hormones to reduce appetite and improve glucose control. These agents can reduce body weight by 10–20% and lower cardiovascular risk.
• Tirzepatide, a dual GIP/GLP-1 agonist, shows even more impressive weight loss—over 22% in trials—by targeting multiple pathways simultaneously.
• Other medications like bupropion/naltrexone and phentermine/topiramate also play supportive roles, although with more modest results or tolerability concerns.

Surgical interventions have become life-saving tools:

• Roux-en-Y gastric bypass and sleeve gastrectomy yield long-term weight loss of 25–35%, often resolving diabetes and sleep apnea.
• These are not cosmetic procedures—they’re powerful metabolic interventions that change hormonal signaling and energy balance.

Multidisciplinary care is essential:

• Teams include dietitians, behavioral therapists, exercise physiologists, and sleep specialists.

• Digital tools—apps, remote monitoring, virtual coaching—add new layers of personalized care and accountability.

CPAP (Continuous Positive Airway Pressure) therapy delivers gentle, constant air pressure to keep the airway open during sleep. It improves oxygen levels, reduces fatigue and daytime sleepiness, lowers blood pressure, and protects the heart, brain, and kidneys.

Today, Taft would no longer be treated with ridicule or guesswork. He’d be met with science, data, empathy—and options that work.

Would Taft Be High-Risk Today?

Imagine it’s 2025. President Taft walks into a modern preventive cardiology clinic.

The nurse takes his vitals.

Waist circumference? Over 55 inches(140 cm).

Blood pressure? 165/98 mmHg—a serious concern, well into stage 2 hypertension. Not just a number, but a signal. Uncontrolled hypertension is a major contributor to heart attacks, strokes, and kidney disease. In Taft’s case, it would demand urgent attention, with immediate initiation of blood pressure-lowering therapies and ongoing monitoring.

His lab panel flashes warnings: triglycerides elevated, HDL low, fasting glucose hovering just below the diabetic threshold. He nods off during the intake interview, despite the morning coffee.

A few questions later, it’s clear: loud snoring, dry mouth, unrefreshing sleep. He’s referred for a sleep study on the spot. ApoB? Elevated. Coronary artery calcium score? Likely triple digits.

By today’s standards, Taft wouldn’t just be flagged—he’d be classified as very high risk for atherosclerotic cardiovascular disease.

But this wouldn’t be the end of his story. It would be the beginning of a full-court medical press:

• Aggressive lipid-lowering therapy—even if his LDL-C looked “normal.”
• GLP-1 receptor agonist or dual incretin therapy for weight loss and metabolic improvement.
• CPAP therapy to improve oxygenation, reduce blood pressure, and lower cardiovascular risk.
• Lifestyle coaching, behavioral support, and dietary restructuring—tailored to his biology, not his willpower.

In 1910, Taft was managing symptoms in the dark.
In 2025, he would be guided by precision tools and predictive analytics.

He would no longer be shamed.
He would be treated.

But treatment—even today—is not universal. Yes, a sitting president would have access to the best specialists, medications, and monitoring. But for many patients living with obesity, sleep apnea, and metabolic disease, access remains unequal.

The tools exist, but they’re not always within reach.

And even when care is available, another challenge remains: the readiness to confront the truth. Denial can be a form of protection, especially in a world that still too often blames the individual instead of the disease. Facing the full picture requires support, compassion, and a willingness to see obesity not as a failure of willpower, but as a medical condition worthy of real treatment.

No More Hungry Bear Diaries

Modern understanding of obesity recognizes its multifactorial nature, including genetic, hormonal, behavioral, and environmental influences. Even modest weight loss is associated with measurable improvements in cardiometabolic health. Effective interventions begin with sustainable lifestyle changes—emphasizing dietary quality, increased physical activity, and behavioral support.

A practical approach involves recommending a high-quality, nutrient-dense diet that patients are likely to adhere to over time. This should be combined with an individualized exercise plan, specifying frequency, intensity, type, and duration, targeting at least 150 minutes of moderate-intensity physical activity per week, in line with current guidelines.

A contemporary clinical approach might guide a patient like Taft toward a structured, evidence-based dietary strategy, such as a Mediterranean or low-carbohydrate pattern, not solely for weight reduction, but to improve insulin sensitivity, lower triglyceride levels, and reduce hepatic fat accumulation.

Time-restricted eating, a form of intermittent fasting, would also likely be discussed. By limiting the eating window—e.g., from 12 p.m. to 8 p.m.—patients may benefit from lower fasting insulin levels, enhanced lipolysis, and improved metabolic flexibility. The goal isn’t caloric deprivation, but aligning metabolic rhythms with behavioral patterns.

Protein intake would be optimized to support satiety and preserve lean body mass during weight loss. Today’s clinicians also have access to tools that were unimaginable in Taft’s era: continuous glucose monitors, digital dietary tracking, and metabolic feedback in real time. These technologies shift the focus from trial-and-error to data-informed care—eliminating guesswork, stigma, and rigid, one-size-fits-all prescriptions.

In essence, the message would not be “eat less,” but rather “eat with intention”—guided by physiology, personalization, and support.

The Verdict

After his presidency, Taft ascended to his dream job—Chief Justice of the Supreme Court. It was a position he cherished. But even as he presided over the highest court in the land, his health continued to falter.

He became nearly blind. His gait slowed. His stamina declined. And although he no longer faced the daily scrutiny of the Oval Office, he remained locked in a decades-long struggle with fatigue, weight gain, and what was likely progressive heart failure.

He died in 1930 at the age of 72. The official cause: cardiovascular disease.

But history rarely tells the full story. What really ended Taft’s life wasn’t a single diagnosis—it was decades of unchecked metabolic risk. A slow fire smoldering through arteries, organs, and energy. Today, we would call it a preventable tragedy.

Lessons from the Bathtub

Taft’s story is not a cautionary tale about indulgence. It’s a powerful reminder of how far we’ve come—and how far we still have to go.

He wasn’t weak. He was methodical. Accountable. Disciplined. He wrote down every bite of food, every fluctuation in weight. He followed expert guidance. He did what he could with what he had.

And still, it wasn’t enough.

Why? Because the science wasn’t there yet.

Taft’s era lacked the frameworks we now rely on: the concept of obesity as a disease, the understanding of insulin resistance, the recognition that sleep apnea can destroy lives silently, night after night.

Today, we have those tools:

• We know how to measure ApoB and assess particle-driven atherosclerosis.
• We can detect subclinical coronary plaque before symptoms ever arise.
• We can prescribe GLP-1 therapies and bariatric surgery with confidence.
• We can treat sleep apnea, hypertension, and insulin resistance as part of one metabolic continuum.

The bathtub may have become a punchline. But Taft’s story deserves better.

He wasn’t stuck in porcelain.
He was stuck in a medical era that didn’t yet understand the disease he was living with.

Next in the Series
The Golf Course Heart Attack – Dwight D. Eisenhower
A sudden collapse during a round of golf sets off a national panic—and forces cardiology into the modern age.

This article was written with the assistance of ChatGPT, an AI language model developed by OpenAI, to help refine and structure the content.