The thing with games as a medium for something with fetish-y content, is that the way we enjoy them clashes with each other.
When you watch porn, you do so for short-onset gratification. If it starts getting too slow or full of ‘filler’, then people can get turned-off. Literally.
By contrast, good games (imo) are engaging, tell a story (whether it’s authored by the dev or by the player - such as in a sandbox game, it’s still a ‘story’) well-paced and capable of holding your attention for a prolonged period of time.
To combine both elements, I feel it’s best to focus first on having a game with a good ‘story’, with the alt content adding to it, rather than being either the sole focus or glossed-over.
While not a game, here’s an example of what I’d rather see in the narrative of a WG game: The Fattest Town - Writing.Com
The quality of it varies (once the older authors stopped contributing, the standard plummeted), but I really like ‘The Fattest Town’, because of the way it approaches the fetish material. In almost every pathway, there’s a clear context; we aren’t just someone bumbling about and becoming a blubberball. She has a motive, an agenda and (at least initially), a clear understanding of what the protagonist wants to achieve.
It’s pretty easy to adapt this into an adventure game. Gameplay would consist of exploration and investigation, while managing a number of variables.
First, ‘physical damage’; if heavily injured (or perhaps, simply too fat to keep investigating) the player just wouldn’t be able to continue. Similar to that, possibly some forms of ‘mental damage’. For whatever reason, the player could be convinced not to continue investigating. Example being the brainwashing that appears in that story a lot. Last, there’s the integrity of the investigation. Attracting too much attention, being cornered or run out of town, or similar stuff. This can feed (heh) into gameplay decisions; if you walk into a diner, do you gratiate yourself with the locals by accepting a large (and potentially-spiked) meal, or something less dangerous - at the cost of missing out on a good scoop or two? Does the player decide to change their objective, by tackling the problem directly, or abandon it completely and choose to ‘lose in style’ instead?
I suppose the other influence I’d throw into the mix is Download Princess Maker 2 | BestOldGames.net which is a rather old-timey in design and look, but also meshes well in the way that it’s character and objective-focused while also giving the player freedom to choose their path to said objective, or take another one entirely (some of the bad endings are pretty hilarious yet also challenging to get).
Doesn’t have to be in a modern setting. Hell, you could easily toss ‘magic’ and other stuff into the mix like PM2 does, but I really like the idea of an adventure game that avoids over-reliance on procedural generation, but still gives the player plenty of ways to reach an overarching objective.