Denise Ruzicka is not sure how much she weighed at her heaviest. Her doctor's scale only measured up to 350 pounds.

She found herself leaving her house less and less. Merely thinking about going some place was exhausting. She'd have to estimate the distance between her car and where she was going then decide whether she could walk that far. Once there, would there be a chair sturdy enough to support her ballooning girth? She never knew.

Her husband, John Ruzicka, remembers how she worried that flight attendants wouldn't allow her on an airplane.

"Here we were, in an airport going to her son's wedding in Jamaica, and she was crying," he says.

She says, "I really thought I was going to lie on the couch and die."

Ruzicka had lost and regained weight several times with different diet programs. In 2003, she weighed 329.8 pounds when she decided to try Weight Watchers one more time.

"I had retired in 2000 while living in San Antonio, and we really wanted to come back to St. Louis," she says. "But I knew I couldn't do what it would take physically to get us back here."

To stay motivated, Ruzicka kept a journal in which she recorded the first time she was able to do stuff that her weight had prevented her from doing, such as tying her own shoelaces, buckling her seat belt and mowing the lawn.

"Everyone was going, 'Yuck! Who wants to cut the grass?' I said I'm not planning on making it a habit, but the fact that I could do it was exciting," she says.

John Ruzicka cheered her on.

"When she'd hit a plateau, we'd go to the grocery store, and I'd say, 'Here's four pounds of sugar. Now try carrying these five (4-pound) bags up and down the aisle,' " he says. "This is what you've lost so far. And she'd realize, that 'Wow, yeah, this is cool.' "

Denise Ruzicka came to realize that losing weight is a slow process that requires making small permanent changes over time.

"And that's what I've done now," she says. "I live the program, and it's easy to live it because you change slowly."

She began by reducing food portions and choosing healthier options to fit the Weight Watchers point system. She eats a lot of the same foods, just less of them. And she prepares them with low-fat, low-calorie ingredients. Fresh fruits and vegetables are part of every meal.

Next, she pinpointed what triggered binging when she wasn't hungry. It was stress.

"Now when I feel like I'm getting in overwhelming situations, I know I need to stop and do something for myself," she says.

One day recently, she says, she was feeling anxious about a long list of errands. So she stopped what she was doing and went to a Weight Watchers meeting.

"Just taking that hour to think through what's important to me, to stop and take a deep breath really helped," she says. "I managed to get everything done on my list, and I probably could have anyway. But it was a matter of sitting and dealing with it rather than using sugar."

At first Ruzicka didn't set a weight loss goal. But she wanted to work for Weight Watchers, and they require leaders to have a healthy body mass index. For Ruzicka, that meant getting down to 155 pounds. So in 2006, three years after starting her weight loss program, Ruzicka set a goal of losing 175 pounds.

Since she'd already lost about 170 pounds, it took her only two more weeks to reach that goal.