But she seemed so sad today. As I looked at her, I understood why. She was 220 pounds in March and is now 190 pounds. But she clearly looks like she weighs 260 pounds. Every time she steps on the scale at home or at the doctor, we are both surprised since she appears to be gaining weight. What causes this? I am attempting to assist and console her, but she and I am both perplexed.
I’d take measurements of at least the breast, waist, and hips and use these to help evaluate if the scale and mirror don’t seem to match.
Is she wearing the same clothes as she did at 220? A baggy fit might make someone appear larger than they are.
Also, how did she lose weight? Is it conceivable that she acquired muscle?
She “visibly” appears 70 pounds heavier? Not believable, bud.
Unless the scale is broken.
Lipedemia and oedema, or loose skin due to weight loss, can both impair look.
I asked my hubby if he had posted this. 
I’ve lost 40 pounds this year and feel bigger than ever. Why? I quit exercising (due to a freak knee injury. I slipped during a walk and dislocated my knee. 5 months later, I’m still working on strengthening it.) & lost muscle mass. Is she working out? Lift weights together to gain muscle. It will make a big difference.
Perhaps the weight loss is from visceral fat, therefore it isn’t noticeable.
It’s most likely loose skin, but she could also be losing muscle if she’s not getting enough protein.
The reality is that, depending on your height and weight distribution, 30 pounds may not be enough to drop one size. People who are heavier tend to wear clothing that is a little too tight. I’m 5’4 and have lost 20 pounds over the last few months. Still wearing the same jeans, although they are more comfortable now. There was an entire discussion about this, I don’t remember where, but many women had the same experience.
I lost weight in my arms, legs, and face initially. It made me look bigger because my stomach and boobs were still so large. Could this be happening to your wife? Does she feel like her clothing are fitting better? Tell her to keep at it. One day, she’ll wake up, look in the mirror, and realise it.
Muscle loss versus fat loss.
If she is dropping quickly, focus on weight bearing workouts.
Check the scale’s accuracy. (Hold a 10 lb dumbbell or a 5 lb bag of potatoes and check the scale to see if you gain the appropriate amount of weight).
If she went from 220 to 190, she shouldn’t look much different, either smaller or larger.
She should try on new garments and see if they are smaller than previously. Comparing to a NONSTRETCHY belt (checking which notch is most comfortable each month) can also be beneficial.
Why didn’t you bring this up with the doctor when you were both there? Social media cannot deliver what could be a medical diagnosis. 
All you’ll get is a collection of assumptions and views.
Perhaps chest to waist to hip ratio? If she lost everything save her tummy, she would appear to be larger but is actually smaller. Sometimes the stomach is the last to go.
I’ve shed 95 pounds, largely through dietary adjustments. I have chronic pain and limited movement, so I focused on my food. I enrolled in the bariatric surgery program because I believed I couldn’t reduce weight without exercising. I went from 275 to 235 and no longer qualified for surgery because my BMI decreased. I’m now 180. It was not easy, but I actually surprised myself.
I lose the most weight when I eat healthily and practise yoga daily. Bodyweight activities in a low-stress setting benefit me more than any weight lifting routine I’ve tried. This includes a year spent with a personal trainer.