WASHINGTON — When Barack Obama underwent a routine physical exam as president, his doctor noted that he had moved on from cigarettes to nicotine gum. Bill Clinton’s doctor included details about his fluctuating weight. Richard Nixon’s doctor complained that he didn’t exercise enough.

There is no legal requirement to follow when it comes to the president’s checkups, and the amount of information released has always been up to the man himself. But President Joe Biden’s exam Thursday will get extra scrutiny because, at 80, he is America’s oldest president.

“There probably is more pressure in this situation,” said Dr. Dan Blazer, professor emeritus at the Duke University School of Medicine. “That’s just our society.”

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Biden’s exam has been delayed for weeks because of what officials said were scheduling issues. White House press secretary Karine Jean-Pierre said the administration would follow the same routine as with Biden’s previous physical.

“We want to be transparent,” Jean-Pierre said Tuesday. “We want to make sure you have the information, and it will be coming from the physician.

In 2021, after a checkup and a colonoscopy at Walter Reed National Military Medical Center, the White House released a six-page letter from the president’s physician, Kevin O’Connor, declaring Biden “healthy, vigorous” and fit to carry out his duties.

He noted at the time that the president had developed a “more pronounced” tendency to cough during speaking engagements and a stiffer gait caused by age-related changes in his spine. He also ruled out the possibility that the stiffness could be caused by a stroke, multiple sclerosis, Parkinson’s or other neurological disorders.

O’Connor did not say in his report whether Biden underwent cognitive testing. While many doctors recommend the testing for older adults, presidents have not regularly made public such examinations, said Matthew Dallek, a political historian.

But because of Biden’s age, “the more positive information, the more Biden can give the public a clean bill of health, the probably more reassuring it is for people,” Dallek said.

Biden has said he intends to run for a second term, but his age has become an uncomfortable issue for him and his party. It also has left him vulnerable to attacks by Republicans.

Nikki Haley, who announced her presidential bid Tuesday, called for “mandatory mental competency tests for politicians over 75 years old,” a threshold that would include Biden and Donald Trump. And in her rebuttal against Biden’s State of the Union address last week, Gov. Sarah Huckabee Sanders of Arkansas called Biden “unfit.”

Biden has dismissed those concerns, telling voters simply: “Watch me.”

Although the tradition of publicizing the results of the president’s physical dates to Nixon, the expectations about how much information to release have varied.

“Even though there are norms in place, each White House can do it differently,” Dallek said. “But of course you cannot divorce the politics from the physicals.”

Dallek said Biden’s level of transparency was “pretty consistent” with that of President George W. Bush and Obama, who both provided information on height, weight and cholesterol. Bush’s doctor said his patient smoked the occasional cigar, while Obama’s physician went as far as saying the president took Nexium for “occasional acid reflux symptoms,” as well as daily vitamin D tablets.

In 2018, the Trump administration sent Dr. Ronny Jackson, then the White House physician, to declare to reporters that Trump enjoyed “excellent health” without initially releasing any basic information, such as weight, blood pressure or cholesterol levels. A memorandum on his health released in 2019 did not detail the physical examinations that Trump underwent, or their results, as the White House physician did for Obama.

Some presidential candidates have gone to great lengths to answer questions about their age or health. In 2008, after Sen. John McCain secured the Republican presidential nomination, his doctors invited about 20 reporters to a room in Arizona to examine McCain’s medical records.

The reporters were given two stacks of medical reports totaling more than 1,000 pages, including lab results, clinical notes, pathology reports, doctor’s orders and anesthesia reports, handwritten notes, and insurance information, much of it from the Mayo Clinic in Scottsdale, Arizona, where he was treated for cancer.

Still, Blazer cautioned that the standard physical reports were limited in how much they could tell you about a president. “The main thing is finding out what he is capable of doing the next year,” he said. “That’s all you could expect of the annual physical.”

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