We didn't address the body image issues directly. DW did say that she was happy that I focused on the positive, that I found her attractive, rather than becoming bitter about the lack of sex. I have been a 'praise what you want repeated' person for a while and that fits into that. Focusing on the negative can make self-fulfilling prophecies.
She is trying to please me sexually the best she can, within her limits. Still one and done, but totally open to this position, that position, whatever I want. Come inside, come outside, while it may not be the best for her, that's ok.
She is trying her best to make me happy and that counts for a lot. However, I get the feeling that she is contented, for now, to only make me happy. No one wants a totally selfish lover, but having someone who is not into it very much for their own sake isn't the best either. Ideally, I would be having fully partnered sex, but life isn't always ideal.
Communication lines are open. I think of marriages as ocean liners. They can sink quickly on the rocks, but they can also get off course without proper attention. It can take slow, steady action to get back on the right path.