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I guess it is possible that it is the repeated episodes of weight gain that cause problems, something certainly seems to go wrong in obesity that seems to get worse the more weight is gained

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Appetite Suppression and Eating Habits One of the main ways semaglutide helps with weight loss is by making people feel full sooner and reducing their hunger

10.1016/S0140-6736(22)01012-1 103 TroubatR.BaroneP.LemanS.DesmidtT.CressantA.AtanasovaB.et al (2021)

What surprised me the most was how much more energized I feelI no longer struggle with fatigue and can be more active without getting tired