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updated 4/17/2008 10:25:31 AM ET 2008-04-17T14:25:31

Q. I am not physically attracted to my wife. Her physical appearance has always been an issue and it only gets worse. She has put on a considerable amount of weight. This is very unattractive to me.

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I’ve tried to hint to her — tactfully; I'm not insensitive — that it bothers me, but she only gets offended. It seems like it’s not my place to say so anymore. Instead, there's this gnawing silence and growing indifference to sex.

I’d like to say that she is so beautiful inside that the outside doesn't matter. But that's not true. In many ways — children, finances, practical things — we communicate well. I respect her and she’s a good mom. But this is a wall between us and an increasing source of emotional distress, anguish, loss of intimacy and hormonal hell. What do you suggest?

A. I get this question often from both men and women: What should they do when their spouse has grown heavier and is no longer physically appealing?

First of all, if you are not especially attracted to your partner from the beginning, as you mentioned, this will not likely change. You should have considered from the start whether this is the right spouse for you, keeping in mind that physical attraction does matter. Over time, people rarely get thinner or better-looking.

You haven't really done your wife any favors. Put yourself in your wife’s shoes: Think how horrible it must feel to be married to someone who doesn’t find you physically attractive.

Healthy couples often become more attractive to each other over time because of their fond feelings and shared history. Plenty of couples continue to have wonderful sex lives despite growing plump and even obese (although obesity should still be avoided, since it can cause health problems).

Your turned-off feelings likely have to do with a lot more than weight. I suspect there are other issues that are harder to pinpoint: You are angry at your wife, you feel awkward being honest with her, you have let your lives become dominated by workday things, you have trouble communicating.

I’m not saying that having an overweight spouse has no impact on your sex life. Sure, your wife might be less attractive to you in the physical sense. And being overweight sends a negative message — that your wife doesn’t care enough about herself, the marriage or whether you have sex. Now, you fear saying anything and she feels you are pulling away, so you are wary around each other, setting off a vicious circle of avoidance and annoyance.

I think you should figure out what the real problem in your marriage is — in other words, confront the emotional issues. Explore why she has put on the weight, what food is replacing for her emotionally and why she isn't tuned in to or sympathetic to how this is making you feel. Be supportive of your wife rather than critical or distant.

There is little downside to broaching the subject directly rather than hinting around. Start not by talking about her weight but about your marriage, your feelings, your sex life. Then ask how she feels her weight affects those important things.

If she wants to lose weight, work on that with her. You can exercise and cook healthy meals together. Do things other than eat. Don’t sabotage her efforts by stocking the pantry with junk food. Be her teammate in solving this problem because plenty of studies have shown that a partner can easily keep their spouse from losing weight, consciously or unconsciously. Some women will keep weight on in an attempt to avoid having sex in the first place. If this is the case, then the solution must go toward the sexual problem first, because the weight is simply the symptom.

Dr. Gail’s Bottom Line: If you’re turned off by an overweight spouse, the fix is in confronting the emotional issues behind the weight issue.

Dr. Gail Saltz is a psychiatrist with New York Presbyterian Hospital and a regular contributor to TODAY. Her latest book is “Anatomy of a Secret Life: The Psychology of Living a Lie.” She is also the author of “Amazing You! Getting Smart About Your Private Parts,” which helps parents deal with preschoolers’ questions about sex and reproduction. Her first book, “Becoming Real: Overcoming the Stories We Tell Ourselves That Hold Us Back,” was published in 2004 by Riverhead Books. It is now available in a paperback version. For more information, you can visit her Web site, www.drgailsaltz.com.

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