Terms of Endurance : Carrying the Weight of the Free World Can Add Far More Than Four Years to a President’s Life

Look closely at the face of William Jefferson Clinton. Are those the lines of last year’s budget battle across his brow?

The bungled nominations of Zoe Baird, Lani Guinier and, now, Bobby Inman; the embarrassments in Somalia and Haiti; the uphill struggle over NAFTA--have they added to the baggage under his eyes and turned his well-trimmed thatch of salt and pepper just a trifle saltier?

Those who have scrutinized our 42nd President during his first year are divided.

“I haven’t noticed too much change in the face, more in the haircut,” said Bernie Boston, a recently retired Los Angeles Times photographer who has photographed every President since Eisenhower.

“He keeps talking about losing weight, but he definitely looks bigger and his hair’s a lot grayer,” said Mike Theiler, who has snapped Clinton regularly for the Reuters news agency.

“His physical appearance varies, but he does look tired very often,” said Robert Gilbert, a professor of political science at Northeastern University in Boston and the author of the book “The Mortal Presidency.”

“The most obvious problem is his weight. He gains weight dramatically and then loses it, then gains again. It puts his heart under stress and he’s at the age where cardiovascular problems become more likely,” Gilbert added.

There is no doubt that the presidency, the mother of all employment challenges, can be a health hazard.

Even discounting the four Presidents who were assassinated--Abraham Lincoln, James Garfield, William McKinley and John F. Kennedy--those who have held the nation’s highest political office have tended to die before the average for their time, Gilbert found. (Supreme Court justices and members of Congress, on the other hand, have been comparatively long-lived.)

Four Presidents--William Henry Harrison, Zachary Taylor, Warren G. Harding and Franklin D. Roosevelt--died on the job of assorted natural causes. Harrison holds the record for the shortest term: 31 days. He expired of pneumonia contracted while speaking for nearly two hours in the rain on Inauguration Day, an argument for short political speeches if there ever was one.

Others didn’t last much beyond their final days in the White House.

James Polk was only 49 when he was inaugurated, then the record for youth. But he was a cheerless workaholic who died three months after leaving office. His secretary of state, James Buchanan, said of Polk: “He was the most laborious man I have ever known and in the brief period of four years had assumed the appearance of an old man.”

Much the same was said of Lyndon B. Johnson, worn down by the war in Vietnam and riots in American streets, when he decided not to seek reelection in 1968. He wrote in his memoirs that he doubted he could survive four more years after his first term ended. He didn’t.

In gauging a President’s health, appearances have sometimes been deceiving.

Kennedy, whose election at 43 broke the Polk record for youth, projected tremendous vigor but was tormented by chronic back pain caused by injuries and the fact that he “was born with the left side of his body smaller than the right,” according to Dr. Janet Travell, one of his physicians, quoted in Gilbert’s book.

Kennedy also suffered from Addison’s disease, a failure of the adrenal glands, which obliged him to take powerful steroid drugs that sometimes left his face puffy.

Michael Beschloss, a presidential historian, said Kennedy actually looked better toward the end of his term than at the beginning, when he was getting “lots of different drugs from lots of different doctors who did not coordinate.”

Still, his back problems may have contributed to his death. Had he not been wearing a back brace on that trip to Dallas, it was suggested in the Warren Commission report on the assassination, he might have been able to duck the fatal bullet.

In contrast to Kennedy, Jimmy Carter, 52 when he took office, seemed to show all the weight of the presidency in his face and carriage.

“He did age noticeably in terms of his hair becoming almost white, but his health was actually pretty good,” said Jody Powell, Carter’s press secretary. Nearly two decades later, Powell noted, Carter, now 70, is “still going at 110%.”

Ironically, it was Carter’s devotion to jogging, more than double-digit inflation or the Iran hostage crisis, that both helped him survive the stress and made him look so haggard. “Carter lost 15 pounds as a result of a lot of running, and that tended to exaggerate the seeming effects of age,” Beschloss said.

Still, the contrast between the anxious ex-peanut farmer from Georgia, with his sagging shoulders and furrowed brow, and the chipper old actor from Hollywood who followed could hardly have been more graphic.

“He was almost the antithesis,” said Stephen Hess, a senior fellow at the Brookings Institution. “Just look at Ronald Reagan. The oldest President coming in, but a man who knew how to slough off responsibilities--or should I say delegate--and didn’t take them upstairs in the White House with him.”

Reagan began to look the septuagenarian he was only in his second term, after cancer surgery and the Iran-Contra scandal. His earlier brush with death, when John Hinckley shot him in 1981, barely scratched the “Teflon.”

And what of Reagan’s successor?

Despite noticeably more hands-on management, a thyroid condition that briefly caused a heart irregularity and some major embarrassments (if minor health events), such as throwing up in public on the prime minister of Japan, George Bush also held up pretty well.

“Bush aged a lot more in the vice presidency,” Beschloss said, “when he had to subordinate himself and his views to Reagan.”

As for Clinton, the experts spoke favorably of his optimistic personality and his efforts to diminish stress.

“Clinton works hard but doesn’t attempt to achieve the level of detail that Carter did, and he’s more comfortable delegating responsibility,” said Philip Tetlock, a professor of psychology at UC Berkeley.

Dr. Suzanne Griffin, a specialist in biological psychiatry at Georgetown University, attributed Clinton’s relatively good shape to “his sense of humor, his interest in other pursuits, such as music, and regular exercise.”

But the President’s fondness for fatty foods and late nights, and the seemingly never-ending succession of crises--personal and political--may not bode well.

“The pressure has got to take its toll,” Powell said. “I don’t see it in his face now, but by the end of four years, I guarantee you’ll see it.”