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I don' think it's her looks that are the unrealistic part. While it may be true that she is not the most attractive on the show, it is also obvious that she is among the oldest on the show. We cannot expect her to look the same as women who are more than a decade younger than her.
What does not make sense is that she has three children, and he acts as if that isn't a huge burden because he is so desperate to be with Meredith. I think they don't show her children too much because then they'd have to address the fact that she has too many children to start over again in life and we would have to see Nathan's reaction to becoming responsible for three children he was not the father for.
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