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But can they ever be a symptom of something else

Stored in fat: Interestingly, lipophilic (fat-soluble) odorants are often stored in your fat tissue.[ref] A recent Danish study found that people with MCS were more likely to have a higher waist circumference and body fat percentage than an age and health-matched control group without MCS.[ref] Perhaps this indicates that more of the lipophilic odorants are stored in fat

That pattern relates more to the magnitude of weight loss than to a special microdose effect

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Tirzepatide after intensive lifestyle intervention in adults with overweight or obesity: The SURMOUNT-3 phase 3 trial