Your response is not really pursuing IMO but it doesn't sound quite right. Hearing and understanding are two very different things. Telling her how she "must" feel is not good either.
I think you need to look at the big picture. Your W does not take care of her health. Instead she buries her head in the sand and sleeps (the blood work is a good first step). You have caught her looking at plastic surgery sites and she wants to go on your insurance to obtain plastic surgery. IMO your W is broken in the inside and is looking for "outside" fixes to make herself feel better. That is a huge problem.
I would simply tell your W when she complains about feeling unattractive: W, sorry to hear you feel that way. Anything I can do to?
If her answer is "put me on the insurance to get work done" then you know where you stand.
If she says nothing then do nothing. Eventually your W will have to put some effort in beyond the daily activities you do. She will have to learn to manage (or change) her work schedule, her physical issues and she will have to learn to communicate better. At some point she will need to show some remorse and not act so entitled towards you.
IMO it is time for you to start turning things around a bit. Validate her feelings and give her the opportunity to come to you. If she doesn't then she doesn't. If she does, well, then we might start to see some progress.
