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      Oprah Takes on Weight Stigma in the Ozempic Era in New Weight Loss Special

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      In a new special, Ms. Winfrey highlighted how new drugs have changed the way we talk about weight and willpower.Oprah Winfrey, a longtime figure in the national conversation about dieting and weight bias, devoted an hourlong prime-time special on Monday to the rise of weight loss drugs. Her goal, she said, was to “start releasing the stigma and the shame and the judgment” around weight and weight loss — starting with her own, she said.“For 25 years, making fun of my weight was national sport,” Ms. Winfrey said in the show, titled “An Oprah Special: Shame, Blame and the Weight Loss Revolution.”Shame has become a focal point in that conversation as new drugs like Ozempic and Mounjaro, which are widely used for weight loss, shift how people think about treating obesity. When Ms. Winfrey disclosed in December that she was taking a medication to manage her weight, she said she was “done with the shaming” that had followed her through decades of dieting.Many patients who start taking these medications say they have felt shamed for struggling with their weight, and then shamed for taking weight loss drugs, said Dr. Michelle Hauser, the obesity medicine director of the Stanford Lifestyle and Weight Management Center, who was not involved with the special.“People just are constantly getting this message, both internal bias and then external bias from other people,” she said. Some might think, “‘I shouldn’t have to rely on medication, I shouldn’t be dependent on them,’” she added.Dr. Hauser tells patients to instead ask themselves: “Would you tell someone that about their blood pressure medication?”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      PCOS Diets Are Unlikely to Ease Symptoms

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      Patients were told for years that cutting calories would ease the symptoms of polycystic ovary syndrome. But research suggests dieting may not help at all.For years, people who had polycystic ovary syndrome and were also overweight were told that their symptoms would improve if they lost weight via a restrictive diet. In 2018, a leading group of PCOS experts recommended that overweight or obese women with the hormonal disorder consider reducing their caloric intake by up to 750 calories a day. That guidance helped to spawn questionable diet programs on social media, and reinforced an impression among people with PCOS that if only they could successfully alter their diets, they would feel better.But the recommendations were not based on robust PCOS studies, and researchers now say that there is no solid evidence to suggest that a restrictive diet in the long-term has any significant impact on PCOS symptoms. Dieting rarely leads to sustained weight loss for anyone, and for people with PCOS, losing weight is particularly difficult. Beyond that, the link between sustained weight loss and improved symptoms is not very clear or well-established, said Julie Duffy Dillon, a registered dietitian specializing in PCOS care.In 2023, the same group, called the International PCOS Network, revised its guidance based on a new analysis of the research and dropped all references to caloric restriction. The group now recommends that people with PCOS maintain an “overall balanced and healthy dietary composition” similar to the Mediterranean diet, which is associated with a reduced risk of the health issues that are linked to the disorder, like cardiovascular disease and diabetes. It’s not known whether eating this way might improve symptoms of PCOS. The changes in the guidelines reflect “the PCOS literature and the lived experience of people with the condition,” said Dr. Helena Teede, an endocrinologist at Monash Health in Australia and lead author of the 2023 guidelines. “It’s no longer about blaming people or stigmatizing them, or suggesting that it’s their personal behavioral failure that they have higher weight.”What is PCOS?PCOS is a hormonal disorder that affects as many as five million women in the United States. It’s characterized by irregular periods, infertility, excessive facial hair growth, acne and scalp hair loss — symptoms that are common with other health conditions, too, making diagnosis tricky. People with PCOS usually ovulate less than once a month and often also have higher levels of androgens (male sex hormones) or multiple underdeveloped follicles on their ovaries (not, as the name suggests, cysts) or both.Typically, when a woman is experiencing symptoms, a doctor will either scan the ovaries to look for those follicles or draw blood to test hormone levels. There is no cure for PCOS; the first line of treatment is often some form of birth control to help regulate the menstrual cycle.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      An Anti-Obesity Drug and Cultural Stigmas

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      More from our inbox:Seeking More Insight Into Republican VotersScandal at Liberty UniversityFree Analysis? Alice Rosati/Trunk ArchiveTo the Editor:Re “Ozempic Can’t Fix What Our Culture Has Broken,” by Tressie McMillan Cottom (column, Oct. 15):By “broken” in the headline, the column implies that we still perpetuate a cultural bias against obese people.Yes, we do stigmatize fat people. I’m fat. What’s also broken, though, is our habit of blaming society for failing to accept us, and medical institutions for failing to fix us, before we take an honest look at our own choices contributing to becoming unhealthy in the first place.Clearly obesity is an epidemic with complex environmental, economic and genetic factors. But for most, physical activity and healthy eating are still nature’s best prevention and remedy. Unlike Ozempic, they’re not a sexy quick fix. They’re work.Maybe healthy eating and activity are just too simple. But viewing ourselves first as victims of unfair systems is also not the answer.Society will always judge. Institutions will always be profit-driven. Blaming is easy. Honest self-assessment and changing habits are hard.Leslie DunnCarmel, Calif.To the Editor:Tressie McMillan Cottom’s fine column covers almost all the issues that I, as a slightly overweight but not obese woman, have with the new weight-loss drugs.But one issue needs to be addressed: What will we think about and how will we treat people (women) who choose not to take this drug, for whatever reason? Maybe it’s because it’s too expensive; maybe because it’s a commitment to a lifetime of taking the drug; maybe it’s just, amazingly, because they are comfortable in their rounded, plush bodies, and don’t desire to change them. Will they face even more opprobrium for that choice than they already do?I’ve spent the last 66 years (and counting) being told that my body isn’t “right,” by doctors, family and society. I’ve just finally come to terms with the fact that I’m stuck in it, and I’m lucky to be able to wake up every morning and get out of bed. Isn’t that enough?Naomi Weisberg SiegelPittsburghTo the Editor:While I agree with the author on many points, one point she didn’t address effectively is that Ozempic and other weight-loss drugs help cover up a main culprit that is causing our obesity: the U.S. food industry and “ultraprocessed foods.”Up until about the 1980s the U.S. didn’t have such a serious obesity problem. Then sugar began being added to everything, along with other things not found in any garden or kitchen.Dr. McMillan Cottom points out that people can be obese and be healthy, but that is not true of most obese people. Ozempic was created because of rampant diabetes in the U.S., the risk of which is increased by eating ultraprocessed foods.Our food industry is killing us with slow deaths from chronic diseases.Deborah JerardMontpelier, Vt.The writer is a pediatrician.Seeking More Insight Into Republican VotersWhy These 11 Republican Voters Like Trump But Might Bail on HimThe group discusses what it would take for a candidate other than Trump to win their vote.To the Editor:Re “Could These Republican Voters Abandon Trump?” (“America in Focus” series, Opinion, Oct. 22):This piece was disturbing but unenlightening about why voters support Donald Trump.Focus groups are supposed to probe for deeper understanding of participants’ views, yet your moderator accepted answers without delving into how participants reached those views.For example, when Cristian said about Donald Trump that “he does get things done,” the moderator could have asked for specifics. It would have been an interesting answer because Mr. Trump actually got very little done.The most glaring omission was Mr. Trump’s false claims of a stolen 2020 election. Do participants agree with Mr. Trump? Where do they get their news? Does this issue even matter to them?We have known for months that Mr. Trump maintains strong voter support. We might have gotten some insight into why had the moderators asked more clarifying questions.Ann LaubachAustin, TexasTo the Editor:First, I will applaud both Kristen Soltis Anderson for her skilled questions and moderation, as well as Patrick Healy and the Times Opinion team for sticking with your amazing series, most recently “Could These Republican Voters Abandon Trump?” Fascinating stuff.But just like the infamous CNN town hall with Donald Trump, it leaves an urgent set of questions. Mainly these:1. What about the criminal cases against Mr. Trump?2. What about climate change and the green agenda?Without understanding in depth these 11 Republicans on these topics, I just don’t see how I can evaluate. Of course, I recognize that these individuals have most likely completely dismissed these entire areas of thought. Nonetheless, to understand the situation in my country, I need to see what rationales they are using to do that.George OdellNewburyport, Mass.Scandal at Liberty University Julia Rendleman for The New York TimesTo the Editor:Re “The Worst Scandal in American Higher Education,” by David French (column, Oct. 23):Thank you to Mr. French for bringing the truly appalling behavior of Liberty “University” officials to our attention. Yet while he reports that the $37.5 million fine Liberty might face would be “unprecedented,” I can’t help but wonder why the Department of Education wouldn’t strip Liberty of its accreditation altogether, making it ineligible to receive federal money.Such a move is long overdue, and not just because Liberty has lied about campus crime and pressured victims of sexual assault to stay quiet. Liberty, and a host of other Christian institutions, are not colleges in the critical sense. These are places where answers precede questions, where intellectual exploration is hemmed in by theological dogma, and where basic tenets of academic freedom are treated as optional.Why should taxpayers be funding education at such places at all?Steven ConnYellow Springs, OhioThe writer is a professor of history at Miami University.Free Analysis?James AlbonTo the Editor:“How Do You Charge a Friend for a Professional Favor?” (Business, nytimes.com, Oct. 21): Another favor-asking situation that commonly occurs is asking physicians, be they friends or a recent acquaintance at a social event, for free medical opinions or even advice. The many ways of handling those situations would warrant an entire New York Times article.There is another common experience that occurs when one is introduced to someone as a psychiatrist, psychoanalyst or therapist in nonprofessional settings.Such introductions often evoke the question, “Are you analyzing me?” To which I almost always respond, “Not if you’re not paying me.” And we move on.Jack DrescherNew YorkThe writer, a psychiatrist and psychoanalyst, is past president of the Group for Advancement of Psychiatry. More

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      Why Dr. Oz Is So Popular: American's Dysfunctional Attitude to Health

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      It’s perhaps an understatement to say that Americans have a difficult and contradictory relationship with our bodies.Every decade or so there is a new optimal way to feed ourselves, along with increasingly outlandish weight-loss regimens and whole categories of foods to champion or fear. We revel in the sophistication of medical science while widely distrusting it, and our politicians refuse to support a health care system in which everyone has access to basic, compassionate care. We are overly sedentary, but when we exercise we value strenuous over relaxing movement, strain over ease, striving over acceptance.No one embodies these obsessions better than Mehmet Oz, known as Dr. Oz to American daytime television viewers. Dr. Oz, who has styled himself as a kind of high priest in the church of American wellness, recently announced his candidacy in the Republican primary for an open Senate seat in Pennsylvania — a race that could decide control of the chamber.As Dr. Oz pursues this pivotal position, he should be seen as more than a celebrity turned politician. He’s rightly understood as a kind of quasi-religious leader, one who has set up his revival tent between a yoga studio and an urgent-care clinic, with the television cameras rolling. And many Americans are primed and ready to commit to his doctrine, which promises boundless possibility so long as we invest in individual responsibility — for our health and for everything else.This is worrying. As we collectively face yet another surge of coronavirus infections, leaders who extol individualism aren’t simply ineffective — they’re dangerous. If there’s anything we should be taking away from the past two years, it’s that autonomy and self-reliance are inadequate for 21st-century problems such as climate change, structural racism and the pandemic.The son of Turkish immigrants, born in Cleveland, and by all accounts a gifted surgeon, Dr. Oz gained notice as a frequent guest on “The Oprah Winfrey Show,” appearances that earned him the tag “America’s doctor” and led to introduction of “The Dr. Oz Show” in 2009. Over 13 seasons, the frequent topics of the show, which at its height regularly drew over a million viewers per week, could also be a list of Americans’ biggest bodily anxieties: weight loss, cancer, weight loss, aging, weight loss, sleep problems, poop problems and oh, weight loss.Dr. Oz often describes his path from cardiothoracic surgeon to TV health expert with missionary zeal: “As I performed thousands of surgeries on patients whose hearts had been ravaged by obesity, I realized we needed to better educate people on how to take part in their own care,” he explained in testimony before a Senate committee in 2014. “And for that reason I went into the public life, in an effort to teach.”And his announcement that he is now making the leap from daytime television to national politics took on a downright rapturous tone: “I’m running for the Senate to empower you to control your destiny,” he wrote in an essay in The Washington Examiner, “to reinvigorate our great nation, and to reignite the divine spark that we should always be seeing in each other.”The thousands of on-air hours Dr. Oz has spent ministering to Americans’ health concerns have made him a multimillionaire, and also a controversial figure. He has praised unproven supplements such as sage leaf tea, green coffee bean extract and raspberry ketones as “miracles” for weight loss and was chastised by senators for doing so. He was part of a team at Columbia University that patented a device to strengthen damaged heart valves, and also was the target of a letter of protest by physicians who asked why the university kept him on the faculty since he had shown “an egregious lack of integrity by promoting quack treatments and cures in the interest of personal financial gain.”On Covid-19, Dr. Oz has been particularly contradictory. He has promoted the safety and efficacy of vaccines and masks, but also initially recommended the use of the malaria drug hydroxychloroquine to treat Covid, based on a small and soon-discredited study. And his bid to represent Pennsylvania in the Senate is based on his promise to free Americans from some of the mask and vaccine mandates that his medical colleagues widely support.“We are Americans, and we can do anything we want,” he tweeted recently, alongside a Fox News clip of himself criticizing the Biden administration’s Covid-19 policies. “It’s time we get back to normal.”If there’s one consistent strain in Dr. Oz’s trajectory, it’s his belief in the power and responsibility of individuals to take control of their health and well being. Strikingly, in his essay announcing his candidacy, Dr. Oz doesn’t speak of unity or community, as many politicians do. Instead he identifies himself as a doctor who is “trained to tell it like it is because you deserve to hear our best advice and make your own decisions.”Perhaps it shouldn’t be surprising that this messianic diet guru would offer to cure us of all that ails us, physically and spiritually. The bigger question is why so many are ready to believe that organic, cold-pressed snake oil could stop us from aging, cure cancer, make us lose weight and end a pandemic?There’s something deeply American in Dr. Oz’s quest to reach a higher state via the improvement of the body. Its roots can be found, arguably, in the spiritual strivings of the Transcendentalists, the group of 19th-century nature-obsessed New England philosophers.Ralph Waldo Emerson’s notion of an “original relationship to the universe,” and his belief that there is a divine spirit in nature and in the human soul that does not require the doctrines and laws of organized Christianity, was radical in its time, but became foundational to the American concepts of individualism and self-reliance. These threads have been woven into everything from the prosperity gospel to my yoga teacher’s instructions to lift our arms over our heads and send our intentions “from Earth to sky through you.”The same ideas, filtered through the 21st-century preoccupation with wellness, quickly arrives at the idea that we shortchange ourselves by accepting what we are told by society — by doctors, scientists or government health officials — if it contradicts our individual instincts or opinions.It’s this American idea that health is a personal responsibility that gives rise to figures like Dr. Oz. In his individualist doctrine, when we get sick it’s generally at least partly our fault — there was probably a supplement we should have taken, a superfood we could have eaten more of or a junk food we should have eaten less of, a specialist we should have consulted.This American predilection for individualism is itself a public health risk in a pandemic, Ed Yong has argued in The Atlantic — one that has led to bad policy that puts everyone, especially the most vulnerable people, at risk. When reducing the spread of an infectious disease requires collective and individual action, “no one’s health is fully in their own hands,” Mr. Yong explains.And yet the idea that your health is in your own hands is key to Dr. Oz’s worldview. Despite what appears to be an earnest desire to help people, “The Dr. Oz Show” is not a public health effort. It’s a business. And by recommending products and services, Dr. Oz offers us opportunities to buy things — a very American way to feel empowered. He helps us find the perfect alchemy of diet, exercise and açaí berries to keep us spry, thin, and disease-free forever, as long as we can pay for it all out of pocket. In our individualist, consumerist society, wealth is health.This perhaps is the deeper, more primal appeal of what Dr. Oz is selling — the idea that if we can find the right guru, buy the right products and strive hard enough to manifest our best selves, we might just cheat death.Which of course we can’t. In this moment, when so much hangs in the balance, it’s a dangerous delusion.Annaliese Griffin is a journalist who covers culture, lifestyle and health.The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram. More

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      Want to Be Mayor of New York? Better Know Your Wings and Dumplings

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      #masthead-section-label, #masthead-bar-one { display: none }N.Y.C. Mayoral RaceWho’s Running?11 Candidates’ N.Y.C. MomentsAn Overview of the Race5 TakeawaysAdvertisementContinue reading the main storySupported byContinue reading the main storyWant to Be Mayor of New York? Better Know Your Wings and DumplingsFood can be a unifying or divisive factor in New York City politics, with people taking sides on pizza slices, deli choices and utensil selection.Andrew Yang has dined around the city, including in Chinatown earlier this month, to highlight restaurants that are struggling during the pandemic.Credit…Chang W. Lee/The New York TimesFeb. 25, 2021, 5:00 a.m. ETAmong all the things that help shape a New York City mayor’s image, it’s not always the most consequential topics that tend to stick — especially on matters that concern food.Just ask Mayor Bill de Blasio.On second thought, maybe don’t ask him: Mr. de Blasio is still remembered for making the mistake of eating a slice at Goodfella’s, a popular pizzeria on Staten Island, with a knife and fork. It was his second week in office.Food can be a strangely unifying or divisive factor in New York City politics, with people taking sides on pizza slices, deli choices and, of course, bagels.That remains true even now, with New York City in crisis, and the mayor’s race perhaps the most important in a generation. Yet with the pandemic forcing much of the campaign inside and online, discussing food — and consuming it at sporadic in-person campaign events — has been a pleasant diversion.Andrew Yang, the former presidential hopeful, keeps a photo diary of his campaign snacks on Twitter: gourmet pickles on the Lower East Side of Manhattan; pizza at Gino’s restaurant in Bay Ridge in Brooklyn; Dominican food in Hunts Point in the Bronx.When Mr. Yang stopped recently for soup dumplings and scallion pancakes in Chinatown, he said that he wanted to highlight restaurants that are struggling during the pandemic.“As much as I enjoyed running for president, the culinary options of New York City are very different than those in Iowa and New Hampshire,” he said. “It’s been delightful for me to think of a type of a food that I want, and it’s available.”Mr. Yang is not the only candidate dining al fresco.After Mr. Yang posted a photo of his lunch with Donovan Richards, the Queens borough president, at Szechuan Mountain House in January, Maya Wiley soon followed with news of having had “slammin’ chicken wings” with Mr. Richards at Queens Bully, a gastro pub.Even before she entered the race, Ms. Wiley, a former MSNBC analyst and ex-counsel to Mr. de Blasio, posted a photo last summer of her Caribbean meal at Code Red in the Bronx with Carl Heastie, the State Assembly speaker — a coveted ally who has not made an endorsement yet.Eating on the campaign trail can be trickier for Eric Adams, the Brooklyn borough president, who is a vegan evangelist and often brings his own food. He grabbed a green goddess smoothie and a quinoa tofu bowl one recent morning before visiting Yankee Stadium in the Bronx to hand out masks.“This will be in the car so I can have healthy options, and I don’t have to nibble on something unhealthy,” he said.Eric Adams, the Brooklyn borough president, is a vegan who published a book last year called “Healthy at Last,” about his plant-based diet.Credit…Chang W. Lee/The New York TimesFor Mr. Adams, his personal transformation from an overweight police officer in the 1990s to a lean vegan who loves yoga and meditation is a key part of his campaign narrative. Mr. Adams published a book last year called “Healthy at Last” about his plant-based diet, with recipes for tempeh stir-fry and jackfruit and okra gumbo.Mr. Adams is serious about his diet after dropping 30 pounds and reversing his diabetes. He has a mental map of the best vegan spots around the city, name-dropping Screamer’s Pizzeria in Williamsburg in Brooklyn, and boasts of his homemade creations like pizza with a cauliflower crust.When Michael R. Bloomberg was mayor, he famously cracked down on trans fats, sugary drinks and salt to try to force New Yorkers to get healthy. But his personal diet was filled with indulgences: He sprinkled salt on bagels and pizza, and enjoyed burned bacon and peanut butter sandwiches, Cheez-Its and Big Macs.Mr. Adams also wants to make public health a focus of his administration if elected, but would undoubtedly be a better model in his personal habits than Mr. Bloomberg.In his book, Mr. Adams describes waking up with vision problems in March 2016 and learning he had diabetes. After years of eating fast food like McDonald’s and KFC, Mr. Adams decided to change his lifestyle, along with his partner, Tracey Collins, a former school principal.The book has plenty of practical advice: “Don’t Brag (When You Start Looking Oh So Good)” and discusses health disparities in the Black community.Now when Mr. Adams eats with community leaders, he first scans the menu for appetizers and side dishes and orders something simple like broccoli or hummus. If he is offered something homemade, he tries to be polite.“I’m a master at moving food around on the plate,” he said with a laugh.Mr. Adams isn’t even the only candidate with a cookbook: Scott M. Stringer, the city comptroller, published one on healthy eating in East Harlem in 2008. But Mr. Stringer is no expert home chef. His contribution to the book was a list of ten tips for ordering takeout, including, “That’s dressing on the side, please.”Mr. Stringer said he learned some kitchen basics after marrying his wife, Elyse Buxbaum, in 2010.“Pre-Elyse, I was a connoisseur of West Side takeout,” he said. “Now I’m proud to say that I’m getting better at cooking. I can make pasta and throw tomato sauce on it.”Asked about his best meal on the campaign trail, Mr. Stringer sounded crestfallen that he remains mostly stuck inside his bedroom closet on video chats.“Takeout sushi in the midst of Zooming,” he said.The silver lining, perhaps, is avoiding the pitfalls awaiting candidates when they make public food choices.For instance, a recent stop for a dan tat, a Chinese egg tart, got Mr. Yang into trouble with his wife, Evelyn.“It was warm and delicious,” he said. “The only problem was that I didn’t bring one home for Evelyn. She saw it on my Twitter feed.”As for Mr. de Blasio, wisdom has not necessarily come with experience. Six years after the pizza fiasco, the mayor suggested that his favorite New York City bagel came toasted — prompting many bagel aficionados to recoil in horror. To make matters worse, Mr. de Blasio’s bagel purveyor of choice did not even have a toaster.AdvertisementContinue reading the main story More

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      A Fight Over Agriculture Secretary Could Decide the Direction of Hunger Policy

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      An unlikely fight is breaking out over President-elect Joseph R. Biden Jr.’s choice for agriculture secretary, pitting a powerful Black lawmaker who wants to refocus the Agriculture Department on hunger against traditionalists who believe the department should be a voice for rural America.Representative James E. Clyburn of South Carolina, the highest-ranking Black member of Congress and perhaps Mr. Biden’s most important supporter in the Democratic primary, is making an all-out case for Representative Marcia L. Fudge of Ohio, an African-American Democrat from Ohio.Mr. Clyburn, whose endorsement of Mr. Biden before the South Carolina primary helped turn the tide for the former vice president’s nomination, has spoken to him on the phone about Ms. Fudge as recently as this week. The lawmaker has also lobbied for her with two of the president-elect’s closest advisers and discussed the matter with Speaker Nancy Pelosi.“I feel very strongly,” Mr. Clyburn said in an interview on Wednesday about Ms. Fudge, who leads the nutrition and oversight subcommittee on the House Agriculture Committee.“It’s time for Democrats to treat the Department of Agriculture as the kind of department it purports to be,” he added, noting that much of the budget “deals with consumer issues and nutrition and things that affect people’s day-to-day lives.”But there are complications. Two of Mr. Biden’s farm-state allies are also being discussed for the job: Heidi Heitkamp, a former senator from North Dakota, and Tom Vilsack, the former Iowa governor who served as agriculture secretary for President Barack Obama.The delicate proxy clash over the post, which is usually not as coveted as more high-profile cabinet positions, has pitted Democrats eager to emphasize issues like hunger and nutrition against more traditional members of the party who believe the department should represent rural America. The sprawling agency oversees farm policy, the Forest Service, food safety and animal health, but also the food stamp program, nutrition services, rural housing and rural development.More broadly, the debate illustrates the challenge Mr. Biden faces as he builds his administration. Every appointment he makes interlocks with others, and if he does not select a diverse candidate for one position it becomes more likely he will for other posts.The Agriculture job specifically is pinching Mr. Biden between two of his central campaign themes, which he repeated in plain terms this month in his victory speech: that he owes a special debt to African-American voters, and that he wants to be a president for all Americans, including those who didn’t vote for him.And nowhere did Mr. Biden fare worse than in rural America, particularly the most heavily white parts of the farm belt.“This is a choice that only Joe Biden can make, and he will make it understanding the unique challenges of rural America and what needs to happen in rural America moving forward,” said Ms. Heitkamp, a moderate who was defeated in 2018 after serving as attorney general and then senator in one of the most sparsely populated states in the country.Recalling her campaign efforts on behalf of Mr. Biden’s “great rural plan,” Ms. Heitkamp predicted the president-elect would “pick the person who can implement that rural plan.”Mr. Clyburn, though, said the Agriculture Department had for too long seemed “to favor big farming interests” over less wealthy people, whether they be “little farmers in Clarendon County, S.C., or food stamp recipients in Cleveland, Ohio,” Ms. Fudge’s hometown.Mr. Clyburn did not mention Ms. Heitkamp, but he bridled at the prospect of Mr. Vilsack reclaiming the department he had led for all eight years of the Obama administration.“I don’t know why we’ve got to be recycling,” Mr. Clyburn said, echoing complaints that Mr. Biden only represents Mr. Obama’s third term. “There’s a strong feeling that Black farmers didn’t get a fair shake” under Mr. Vilsack, Mr. Clyburn said.Mr. Vilsack did not respond in kind. He said he had “all the respect in the world for Representative Clyburn” and that he had learned from him.The former Iowa governor, who with his wife was an early supporter of Mr. Biden in his first campaign for president and again this year, said he was not angling for the agriculture job but was careful not to disclaim interest in the position.“If there’s something I can do to help the country, fine,” Mr. Vilsack said. “But the president-elect makes that decision.”When he does, he will be fully aware of where one of his most prominent supporters stands.In addition to his conversations with Mr. Biden, Mr. Clyburn has reached out to Steve Ricchetti, who will serve as a counselor in the White House, and Ted Kaufman, Mr. Biden’s longest-serving adviser and former chief of staff.House Democratic leaders are sensitive to creating vacancies in the chamber, even in safe districts like Ms. Fudge’s, given their slender majority. Gov. Mike DeWine of Ohio, a Republican, might not schedule a quick special election to replace her. But Mr. Clyburn said he was hopeful from his conversation with Ms. Pelosi that she “would greenlight” Ms. Fudge.Drew Hammill, a spokesman for Ms. Pelosi, declined to comment on the discussion. But he signaled that the speaker, who appointed Ms. Fudge as the chairwoman of a subcommittee two years ago to defuse a potential rivalry for the speakership, would not object to her departure.“The speaker wants the full contribution of House Democrats to the Biden-Harris mandate and to the future represented in the administration,” Mr. Hammill said.Like other positions, the Agriculture Department decision could be settled by finding an alternate post elsewhere in the administration for whoever is passed over.A spokesman for Mr. Biden’s transition declined to comment on the appointment but said the president-elect was “prioritizing diversity of ideology and background as he builds a team of experts that looks like America to serve in his administration.”Ms. Fudge, though, has other important advocates, including Senator Sherrod Brown, Democrat of Ohio, who said he had made the case for her “with four or five top Biden transition people.” Her colleagues on the House Agriculture Committee have also been supportive.“It is time for a hunger advocate to lead the Department of Agriculture, and nobody could lead the agency better than Marcia Fudge,” said Representative Filemon Vela, Democrat of Texas.Most significant, though, are three Black House Democrats who are close to one another and Ms. Fudge. The group includes Mr. Clyburn, Representative Bennie Thompson of Mississippi and Representative Cedric Richmond of Louisiana, who is leaving Congress to become a senior adviser in the White House.As for Mr. Biden, Mr. Clyburn said, “he likes Fudge a whole lot.”Recounting his conversation with the president-elect, the congressman said he wanted to let him make the decision. “I just told him I thought she’d be a very good candidate and help refocus what the department is all about.” More