Taft and Pickwick: Sleep Apnea in the White House

John G. Sotos, MD

CHEST. 2003;124(3) 

In This Article

Abstract and Introduction

As President of the United States from 1909 to 1913, William Howard Taft's minimum body mass index was 42 kg/m2 . This article presents evidence that he suffered from obstructive sleep apnea, manifested by excessive daytime somnolence, snoring, systemic hypertension and, perhaps, cognitive and psychosocial impairment. As president, Taft's hypersomnolence was severe and obvious, but never prompted official discussion of his fitness to govern. Within 12 months of leaving office, Taft permanently lost over 60 pounds. His somnolence resolved. As Chief Justice of the United States from 1921 to 1930, he was not somnolent. President Taft's case illuminates historical puzzles of his performance as President, raises public awareness of sleep apnea, and informs discussions of presidential disability and the 25th Amendment to the Constitution of the United States.

I have lost that tendency to sleepiness which made me think of the fat boy in Pickwick. My color is very much better and my ability to work is greater.

William Howard Taft
President of the United States
June 28, 1909[1,2]

William Howard Taft was President of the United States from 1909 to 1913, and Chief Justice of the United States from 1921 to 1930. Despite this unequalled record of achievement, "Taft is remembered, if at all, for being the fattest president. His obesity has become a staple of quiz shows and trivia games, a humorous sweetener that generations of historians have sprinkled through bland lectures."[3]

Taft's obesity was not a humorous sprinkle. I will present evidence that Taft suffered from a serious complication of obesity, severe obstructive sleep apnea (OSA),[4] before and throughout his Presidency. Because OSA can cause hypersomnolence, psychosocial difficulties, and neurocognitive defects,[5] it is appropriate to ask whether Taft was disabled by his illness. I will, therefore, also describe how his inner circle and his physicians reacted to his manifestations of OSA. Taft's relationship to Sir William Osler is particularly instructive, since Osler was one of the few physicians of the era attuned to the medical implications of sleepiness in obese patients.

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