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They have a disease, not just by elevated BMI, because that could be muscle mass it doesn't have to be body fat

Clinical observations from GLP-1 trials have shown improvements in liver enzyme levels, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), among patients receiving semaglutide

Neumann J, Gupta RC, Schmitz W, Scholz H, Nairn AC, Watanabe AM (1991) Evidence for isoproterenol-induced phosphorylation of phosphatase inhibitor-1 in the intact heart

Furthermore, the two treatments may interact with other medications you may be taking