Cook sausage in a skillet over medium-high heat, stirring until it crumbles and is no longer pink; drain.
Bring 4 1/2 cups water and salt to a boil in a large saucepan; add grits. Cover, reduce heat, and simmer, stirring occasionally, 10 minutes. Stir in sausage, cornmeal, and pepper; cook, stirring occasionally, 5 minutes. Spoon into a foil-lined 9- x 5-inch loafpan; chill 8 hours.
Remove loaf from pan; cut crosswise into 1/2-inch-thick slices.
Cook slices, in batches, in a skillet coated with cooking spray over medium-high heat 5 minutes on each side or until browned. Serve with desired toppings.
NOTE: For testing puposes only, we used Smithfield 40% Lower Fat Sausage.
