Harvey touched on something that I have certainly heard before: "...she ain't what she used to be." To this I can only say, "Who is?" The fact remains that if, indeed, love is still a part of the relationship, it almost by definition includes sharing all of the pleasures that go with it. If a partner truly loves what is on the inside, the outside remains as little more than a vessel. In fact, it always was. (Or in my view, it should have been.)

On the other hand, I have seen people, myself included, allow themselves to stop caring about their overall health. I'm not talking about appearance, although that is connected in a big way. As the years roll on we fail to realize that our bodies, which were once "on automatic" now require genuine effort to remain vital and healthy. Most of us don't make this a priority. The folks who do, who are steadfastly committed, stand out in the crowd. We've all seen them. Many of us make repeated efforts toward accomplishing the same end result; but our lack of committment almost invariably defeats us. The people who can maintain that committment are rewarded not only with healthy-looking bodies, but also with changes that are much less visible.

I suppose what I am saying is that often when we let slide our outward appearance, we are manifesting some problems of the spirit and psyche. In many instances, addressing the physical issues can affect changes in the more etherial ones.

If a partner says he is turned off by changes in body image, he/she could also be reflecting attitudes about the non-physical changes that accompanied them. In other words, he/she might not be too keen on some aspects of what is now on the inside, either.

As Harvey also pointed out, often people do not discuss this sort of issue with their partner for fear of hurt feelings. It is a shame that this is so; but it often is. They cover it up by saying "It's not you, it's me" and refuse to say anything more. While they think they are being kind, they leave their partner with no intimacy and with no idea of why there is none. How kind is that?