March 3, 2010 -- The president may be "in excellent health and 'fit for duty'" according to his doctors, but that did not stop physicians around the country from scrutinizing Barack Obama's medical exam results after their release Sunday.
Some gastrointestinal experts questioned the decision to give the president a "virtual" colonoscopy rather than the more accurate -- but more invasive-- conventional screening. Several cardiologists suggested that Obama's rising cholesterol levels would warrant a decision to put him on cholesterol-busting statins. Still, many doctors felt that the recommendations Obama received were appropriate -- namely, stub out his cigarette habit, and eat a bit healthier.
They were recommendations that White House press secretary Robert Gibbs reiterated to reporters Monday.
"The bad cholesterol measure was slightly elevated from where it had been previously," Gibbs said. "Obviously, he's a few years older from when it was last measured." But he later added that Obama has likely been indulging in more desserts than he should have over the past year.
"He's just got to use a little bit more presidential restraint," Gibbs said.
A virtual colonoscopy uses X-rays, while a conventional colonoscopy involves the insertion of a flexible tube into the colon while the patient is under anesthesia. A White House spokesman said on background that the president's doctor had his reasons for recommending the virtual procedure -- not the least of which was the fact that the virtual approach would not require the president to be sedated, thus sidestepping possible transfer-of-power issues.
'Virtual' Colonoscopy as Good as the Real Thing?
"In this case, the doctors believed that all things were equal," the spokesman said. "And it seemed fine to do the virtual colonoscopy. The team there gives top-notch care, and they do this virtual procedure often."
Still, some gastrointestinal experts said that for cancer detection, the conventional option is still the best choice.
"Conventional colonoscopy is widely considered superior to virtual colonoscopy for detection of small polyps, while the two are about equivalent for larger polyps," said Dr. Douglas Rex, director of endoscopy at Indiana University Hospital in Indianapolis.
Additionally, Rex said that the U.S. Preventive Services Task Force has declined to recommend virtual colonoscopy for screening based on the frequency of false positives associated with the test, as well as the fact that it exposes patients to a certain degree of radiation, which he said is "more relevant to younger [patients] like President Obama, as they have a longer life expectancy and a greater chance to experience risk, especially from repeated testing."
Dr. Blair Lewis, clinical professor of medicine at Mount Sinai School of Medicine in New York, said he was "surprised and a bit miffed" at the choice.
"[Virtual colonoscopy] is not a covered service under Medicare and many third party payers. It has also come under fire recently due to the varying doses of radiation used and the long-term health risks," Lewis said.
"I am concerned this sends the wrong message to millions of Americans in several ways. The president is receiving medical care that the average American cannot and probably should not receive, he is being treated in a way not recognized by many medical societies, and he is avoiding a test -- colonoscopy -- that millions of Americans are avoiding wrongly. Not a great way to lead by example."
Still, a number of gastroenterologists applauded the fact that Obama received a colonoscopy at all.
"Any screening for colorectal cancer is better than not being screened at all, so the president is setting a good example by getting a colorectal cancer screening exam," said Dr. John Petrini, past president of the American Society for Gastrointestinal Endoscopy. "Hopefully, his exam will open a dialogue between more patients and their physicians about at what age to screen and which screening option is best for them, as each screening option has appropriate applications and limitations."
Radiologists, too, supported the choice.
"Virtual colonoscopy is an accepted way to screen for colon cancer as recommended by the American Cancer Society," said Dr. Michael Macari, section chief of abdominal imaging at the New York University's Langone School of Medicine. "So I think it is a great choice. You do not want the president of the U.S. under anesthesia if you can avoid it."
Obama's Cholesterol Concerns: Should He Take a Statin?
Even though the president's cholesterol levels have worsened since his last exam in July 2008, most cardiologists contacted by ABC News said that the recommendation of the White House physician to try diet and lifestyle changes first is the right call.
Dr. Clyde Yancy, cardiologist at Baylor University Medical Center in Dallas and president of the American Heart Association, said that according to the American Heart Association's health assessment tool (available at www.heart.org/mylifecheck), the president's stats and lifestyle are not all that bad.
"The president gets a score of 7.2 on a scale of 1 to 10 on the AHA health assessment tool; clearly not a bad score and likely better than most Americans, but there is room for improvement," Yancy said. "The major issues here are smoking, lowering the cholesterol and improving the diet."
Still, there is no question the president's cholesterol is on the rise. The results of Obama's last physical showed his total cholesterol to be 173, while his LDL was 96 and HDL, or good cholesterol, was 68, according to The Associated Press. However, this time Obama's total cholesterol was 209, with his HDL having dropped to 62 and his LDL hitting 138.
These levels place him right at the borderline of high cholesterol, which starts at 200 for total cholesterol and 130 for LDL cholesterol -- prompting some cardiologists to suggest that the president should be taking a statin.
Obama "absolutely should be on a statin, especially in view of his smoking," said Dr. Douglas Zipes, editor-in-chief of the journal HeartRhythm.
Cigarettes Have Got to Go, Docs Urge
Other doctors suggested a wait-and-see approach to give lifestyle interventions a chance to take hold.
"Given the big jump from before, I'd advise dietary modification and rechecking in a couple of months," said Dr. Cam Patterson, director of the University of North Carolina McAllister Heart Institute and chief of the division of cardiology at UNC. "If his LDL remained elevated, I'd have a discussion about starting a statin.
"He's got two other cardiovascular risk factors -- male sex and smoking. In the 20th century, heart attacks killed more U.S. presidents than any other disease."
But if there is one point on which all doctors agree, it is that the president should kick his smoking habit for good.
"A good deal of his overall cardiovascular risk, at his age, is driven by his difficulty in quitting smoking," said Dr. John Bisognano, director of clinical preventive cardiology at the University of Rochester in Rochester, N.Y. "His physicians are right to focus on this issue and it illustrates how truly difficult it is for a person to stop smoking."
ABC News' Sunlen Miller and Jake Tapper contributed to this report.