The 48-year-old, 180-pound Obama was declared "fit for duty" and in excellent health by White House physician Jeffrey Kuhlman this weekend, after his first physical exam as president. But the doctor expressed concern about problems that millions of Americans share, cigarette addiction and high cholesterol.
"Getting cigarettes totally out is what you have to shoot for," said ABC News' Dr. Richard Besser. "He shouldn't give up. He's in a great position to teach the country about how hard it is, but how you can succeed."
Even among those who use the nicotine gum, 30 to 40 percent revert back to smoking, Besser said.
Ninety percent of those who try to quit on their own start smoking again within a year.
Even those who smoke three cigarettes a day have about 70 percent of the risk of those who smoke two packs a day, according to Besser, meaning that even light smokers are not immune from the hazards of smoking.
"It's easier to quit if you're a light smoker versus a heavy smoker, but he hasn't quit," Besser said. "There are a lot of cardiovascular problems from just a few cigarettes a day."
The president has the heart rate of an athlete, but his LDL -- so-called bad cholesterol -- is at 138 milligrams per deciliter of blood, up 42 points since 2007 and rated "borderline high" by the American Medical Association. The average is 114.8.
The cholesterol is not high enough to require medication and can be controlled by diet, doctors said.
"He's going to tackle it by eliminating those bad fats and adding those fruits, vegetables and fiber," to his eating regiment, Besser said.
President Still Struggles With Smoking
Obama is not a heavy smoker but has acknowledged in the past that he occasionally falls off the wagon.
"The president continues to chew nicotine gum," White House Press Secretary Robert Gibbs said Monday.
Obama spoke about his proclivity for Marlboros in an interview with McClatchy Newspapers in June.
"I don't do it in front of my kids," he said. "I don't do it in front of my family. And, you know, I would say that I am 95 percent cured.
"There are times where I mess up," Obama added. "Once you've gone down this path, then, you know, it's something you continually struggle with."
The president made those remarks after he signed the Family Smoking Prevention and Tobacco Control Act giving the U.S. Food and Drug Administration authority over tobacco products, banning all cigarettes from having candy, fruit and spice flavors as their characterizing flavors, and stopping youth-based marketing such as tobacco manufacturers sponsoring sporting, athletic and entertainment events using tobacco product brand names and logos.
That may not be enough for first lady Michelle Obama, who told "60 Minutes" in 2007 she "hates" smoking and that her husband had to quit.
"That was one of my prerequisites for, you know, entering into this race. Is that, you know, he couldn't be a smoking president," she said.
"Please, America, watch," she added, laughing. "Keep an eye on him and call me if you see him smoking."
But much has changed since 2007 and Obama has assumed the weight of the world, one of the apparent reasons he occasionally goes back to cigarettes.
"I can't imagine that that helps," Gibbs said Monday. "While he's quit smoking, he is -- occasionally falls off -- off the wagon when it comes to that, and -- like many who have struggled with kicking that habit."
Obama in Excellent Medical Shape, but Faces Higher Cholesterol
Smoking can impact a patient's LDL, which was the doctor's second concern.
"There are a lot of cardiovascular problems from just a few cigarettes a day," Besser said.
The White House blamed Obama's elevated LDL level on the 2008 campaign diet and having a White House chef at his beck and call.
"I think, candidly, if you asked him, the diet of, first and foremost, a campaign is not as conducive -- we were all living and, thankfully, breathing examples of that," Gibbs said. "I think he would be also the first to tell you that he ... has probably had a few more cheeseburgers, and I think he would admittedly tell you he's had more desserts ... in the last year than ... I've seen him eat prior to this."
On the way back from the Naval Medical Center this weekend, the president said, per Gibbs, "Look, I just have to say no to dessert more often."
The president's obsession with pie, or at least with saying "pie" in speeches, was well chronicled during his presidential campaign.
The president told the Associated Press in July that the White House pastry chef makes "the best pie I have ever tasted, and that has caused big problems with Michelle and I. ... Whatever pie you like, he will make it and it will be the best pie you have ever eaten. And so, we are having to figure out how to resist ordering pie every night."
During his physical, the president also underwent a virtual colonoscopy instead of the standard procedure. Some colon specialists expressed concern about that but most backed the decision, given that the president would have to go under anesthesia, which requires a temporary transfer of power to the vice president.