The pictures relate a compelling story far beyond the proverbial one thousand words. They depict in clear, unambiguous terms, the physical evolution of Roosevelt Skerrit, from the 31-year-old with the boyish, angelic look who became the world's youngest prime minister in January 2004, to the fuller, more rounded figure with the rapidly receding hairline that he is today.

"I find he's aged a lot in recent years," one person close to the prime minister tells The Sun.

Running a small economy such as Dominica's can take a physical toll on those sitting in the prime minister's chair, and the severe stress which they face can sometimes be catastrophic.

Dominicans will recall the deaths of Rosie Douglas at the age of 58, after only eight months in office, and Pierre Charles at age 49, three years older than Skerrit is at present.

"I've heard several leaders complain that it's easier to be president of the United States than to be a leader of a small country. It's more stressful because you have to personally deal with so many matters," Peter Wickham, the Barbadian pollster and political scientist who has worked with many a Caribbean leader, including Skerrit, tells The Sun.

In the past 50 years or so a dozen Caribbean prime ministers and two executive presidents have died in office, the vast majority of them from heart-related diseases and stress.

While the former Barbadian Prime Minister Erskine Sandiford, (now Sir Lloyd), survived, he had an angina attack in his seventh year in office, and spoke nearly two decades ago about the stress which leaders are under and the toll it takes on their lives.

Sandiford became prime minister in 1987 at the death in office of Errol Barrow, and two years after Tom Adams became the first sitting Barbadian prime minister to die in office. Adams was 53.

Sandiford was voted out in 1994 after losing a no-confidence motion amidst a faltering economy.

"I was sitting beside this leader and he just collapsed. It is a major problem and it is stress. The doctors can say what are the causes of death, but I know that a contributing factor in the life of a busy leader is stress," he said in 2000.

"I had to deal with problems at the highest levels and the weight of having to take decisions is what brings on the stress because when you have to take weighty decisions that is a weight on your shoulders, on your heart, your entire body. At budget times sometimes, I never used to sleep on those days leading up to the budget."

Managing the economy is the primary stress factor for any leader of a small country, Crispin Gregoire, the career diplomat and former ambassador to the United Nations, agrees.

"Pierre Charles was under a lot of pressure because the economy was bad," says Gregoire, who was close to Charles, who like Gregoire, was from Grand Bay.

"At the top [of the list of stress factors] is the issue of unemployment and the economy. In Dominica's case the economy has been in decline," he adds, although he explains that Skerrit's ability to raise money has helped ease some of the pressure.

"I must say he has been remarkable in terms of raising money. That has helped to release a lot of the pressure that a lot of leaders face . . . The other thing is political support, and Skerrit doesn't have a problem there."

Eighteen years ago, Sandiford advised prime ministers to exercise daily and to have a healthy diet.

The need for regular exercise, as well as rest, never escaped Dr. Keith Mitchell, who has led Grenada since 1995, with the exception of the 2008 to 2013 period when he was leader of the opposition.

"I've heard Keith Mitchell say he takes a siesta every day. So he exercises in the morning and takes a siesta in the afternoon. Mitchell always says that was something passed on to him by [former Grenadian leader Eric] Gairy," Wickham says.

It is not entirely clear how Skerrit manages the stress that comes with the job, but Wickham guesses that "the fact that he's younger helps, and up to recently he was single, so he had a whole lot more time".

But he is not as young anymore, and the stories the pictures tell are glaring.