A year ago, Debbie Belle found herself in the same unhealthy situation as one-third of American adults. At 5 feet 6 inches and 221 pounds, she had a body-mass index above 30 and was officially obese, according to weight criteria set by the Centers for Disease Control and Prevention.
Belle, 54, had tried several of the best-known programs on the multibillion-dollar weight-loss market. She enjoyed early success with one or two. But each turned out to be too pricey, too stress-inducing or too unwieldy to keep her committed for the long haul.
Then, she says, she tried the cheapest, lowest-pressure, most self-effacing program she'd ever run across, and the decision transformed her quest for better health.
Belle joined Taking Off Pounds Sensibly, or TOPS, a national nonprofit that promotes peer support and personal determination to encourage members to avoid crash diets and instead adopt healthy lifestyle changes. Its goal is to help the average person lose weight moderately and manageably — and to keep it off.
Belle, who lives in Nottingham, has shed 74 pounds in 11 months on the program and, more statistically promising for her health, has maintained her target weight of 147 since reaching it months ago.
She won a divisional first-place prize at a statewide TOPS convention in Ocean City this month for her efforts.
But the ribbon and affirmation Belle received were far from the only reason she intends to never to give up the $32-per-year program.
"It isn't a quick-fix approach or a diet program," she said. "The goal is to make weight loss permanent. I get such deep support and encouragement from my TOPS family. Never once have I felt judged, and I mean 'never' with a capital 'n.' That has all helped motivate me not just to lose the weight but also to keep it off."
Belle's experience with TOPS, a nationwide nonprofit with 63 chapters in Maryland (including 18 in the Baltimore area), is in some ways a model of what weight-management scientists — as opposed to those who market weight-loss programs — have been arguing for years: that when it comes to losing weight, participants' long-term health is more important than their appearance; that a slow and steady approach is healthier than a quick and splashy one; and that it's just as important to maintain weight loss as to achieve it in the first place.
Dr. Kimberly Gudzune, an assistant professor of medicine at the Johns Hopkins University and a leading researcher in weight-management science, said a study of 32 popular weight-loss regimens she led in 2015 suggested that the TOPS approach is effective. But what interests her more than any single program is exploring and explaining the tenets that lie behind any program that works.
Research has long shown that obesity increases the incidence of diabetes, heart disease, hypertension and a host of other dangerous medical conditions.
Gudzune said those who wish to lose weight would do well to look at what TOPS and a few other organizations emphasize — in contrast to most programs in the $40 billion- to $60 billion-per-year weight-loss industry.
"If you look at the market of proprietary weight-loss programs, you'll generally see two main camps," she says. "One spotlights dramatic losses by using ads with models holding up these very large pants, then tiny ones in the next photo: 'Lose 100 pounds in three months!'"
Others "advocate a more regimented change in lifestyle, changes you can actually keep up for the rest of your life," Gudzune said. "I usually prefer a steadier, more purposeful change."
Given her weight loss, Belle might appear to exemplify the quick-fix camp, but what originally attracted her to TOPS was the gently supportive, user-friendly approach it has promoted for 70 years, always without paying for advertising.
Trying a better-known national program for more than a year, Belle said, helped her shed 100 pounds, but she regained it within few months.
In retrospect, she said, that program called for such rigorous calculation of weight-loss points it was hard to keep up. What's more, its monthly membership fee, which added up to $540 per year, was too high. She also felt the company representatives who ran the meetings were often judgmental, and the program reduced its accountability requirements once participants hit their target weight.
"They only asked you to come back once a month after you make your goal weight, and I need it once a week," Belle said. "I can be disciplined, but when it becomes too hard to keep up, it's easy to fall back into bad habits."
She then checked out TOPS. She'd heard the program operates in self-organized chapters in churches and senior centers.
At her first meeting with the Fallston chapter she felt as though she had met 30-plus soul mates.
They encouraged her that night —and welcomed her developmentally disabled adult son, David, into their midst.
After two meetings, she said, she began getting motivational cards from the group and realized they felt like family.
Taking advantage of TOPS literature on exercise and nutrition, she began taking what felt like manageable steps, swimming at a local community college, doing morning walks with David, and maintaining a regimen of "calorie cycling" — 1,800 calories on high-exercise days, 1,200 on the rest.
The positivity of the feedback — and weekly weigh-ins — motivated her not to quit, she said, and to add gradually to her chosen exercise regimen. She now swims 30 laps a day three times a week, walks for an hour at a rapid clip four times a week, and rarely goes back for seconds at meals.
Perhaps most important, she said, TOPS doesn't let up after members hit their target weight; it places them in its coveted "KOPS" (Keeping Weight Off Sensibly) category, and the positive feedback and weekly expectations continue.
Like most programs in an industry regulated more by the Federal Trade Commission than by federal health agencies, TOPS has never been subjected to the randomized clinical trials that would measure its effectiveness against that of its rivals.
But one weight-management researcher, Dr. Nia S. Mitchell of Duke University, became interested in TOPS while seeking weight-loss alternatives for her lower-income clinical patients 14 years ago.
She found in longitudinal studies that members who stayed enrolled year to year generally lost between 5.9 percent and 7.1 percent of their original body weight over three years, easily eclipsing the 5 percent considered a benchmark for significantly improving one's overall health.
And most of those who stayed with TOPS for seven straight years kept the weight off.
"I see continuous engagement as a key to the weight-loss maintenance success of TOPS," Mitchell said.
Mitchell and Gudzune agreed that however one loses weight, it takes work to keep it off, and anyone who's serious about weight loss should expect to keep at it permanently.
Belle, whose BMI has fallen to a healthy 23.7, now sees that as a reachable goal.
"I plan to to stay with TOPS the rest of my life," she said.