She may not associate her weight loss with looking “better” because the weight loss was facilitated by her mental health struggles. I mean, imagine if you had cancer and lost weight, every told you how much better you look.

Her self consciousness and self esteem is probably tied to her depression. Hard to feel good about yourself when you aren’t well.

Also it might just be something she’s trying to work through for herself. I’d stay out of her self image issues. They are hers to sort out. But that’s just my opinion.

I'd be very careful about how I responded to this.

It is hers to sort out, and as long as you keep it kind, positive, and simple, you should be able to get through this challenge without too many things happening.

You're doing a terrific job of checking out options and being present for her.

This may not be the case for everyone but for me, my husband has learned to tread really lightly when it comes to anything to do with my weight, my appearance, etc. It never comes out the way he thinks he hears it in his head. Even when I’m in an ok place with my weight or when I feel good about myself, I prefer he stay out of that aspect of my “self.” He sees it as trying to help. It never translates that way to me though. I perceive it as condescending, and as judgement. I don’t need his advice on my body. I’d rather gain 30lbs out of spite.

But like I said that’s just me. Clearly it’s a sore spot, haha!

Thanks good comments. Let me clarify like most men, I didn't know my wife's weight for a good 4 decades, only when she became ill did I see on hospital records and speaking with her internist.

Interestingly there's different advice here than from her friends. They say I need to be more assertive with her, push for regular walks, physically watch her take her medicine to assure compliance while the predominant thought here seems to be respect her wishes and let her make her own way.

And candidly my wife sorted out her own life pretty well for a number of years, spending money how she saw fit and making plan not not only her but us. But today as she struggles and asks for help, of necessity, I get involved.

As to self-image, I have learned, and certainly with a daughter, granddaughter, even a son, I'd be careful about commenting about weight, as people's perception of self-image is certainly important.

.

I think there are ways to encourage that aren’t overbearing. For instance, I think saying, I am going for a walk do you want to come is different than telling her she really needs to exercise.

I see being assertive differently than her friends. To me watching her take medicine to ensure compliance sounds like an institution. Yikes. My mom had dementia. I had to administer her medication because she could not. Your wife knows she should take her medications. How will she ever find independence and balance in managing herself if you are always there to manage the situation?

I agree with rmb. This is her personal struggle. If and when she wants to get well, it will be up to her. However, you do deserve to state your concerns since a marriage is not just about one person, but two. Tread carefully.