I'd be very concerned in that I'd see it as a symptom of a bigger problem. The first thing I'd want to know is why she gained 30 lbs. The answer to that question would determine my course of action. If it's a matter of depression or some major life event that changed her outlook, I'd do my best to help her recover and regain her self confidence. If it was just pure slovenliness, I'd consider a breakup. This is assuming a girlfriend, not a wife. I would never consider a divorce over such an issue unless the root cause of the weight gain also caused unresolvable differences that caused the marriage to break up. Having said this, I feel very fortunate that I've never had to deal with this issue. After 7 years and one pregnancy she's still the same size she was when I met her.
As for the second question, my wife wanted me to grow a mustache practically ever since we met. After a few years I finally gave in, despite the fact that I knew it wouldn't look good. When I finally did grow it, no one explicitly criticized it, but I knew from people's reactions that they didn't like it. I should say at this point that I was wearing a goatee at the time, decided to shave it and, for her sake, left the mustache for a while. After a few months, I shaved the mustache. A while later, she admitted that it didn't look good and she was sorry for having insisted on it. I suppose the whole point of this longwinded story is that I made a change to my appearance despite the fact that I knew it wouldn't look good, but it was for the good of our relationship and I'd do it again in a heartbeat if it was for her sake. I think the key in this case was that it was something she genuinely wanted and thought would truly make me more attractive. In other words, she did it more for me than for herself. If her motivations were more selfish, I probably would not have given in.
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A truly open mind will seriously consider all points of view, even those with which it strongly disagrees for there may be a grain of truth in even the most ridiculous of opinions.
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