Difficult to know.
One obvious issue is whether it is half-starved. Is it eating properly and sufficiently? Puffers have a high metabolism, and it is best to give them several, relatively small meals in most cases. The piscivorous ones are adapted to eat a lot at once and then rest for a day or two, but the ones that eat invertebrates, like GSPs, feed more or less continuously in the wild.
Puffers need a mixed diet, and while many will clearly favour one food type (with my South American puffer, its bloodworms) you do need to train them to take a variety of things. Otherwise vitamin and mineral deficiencies become real problems.
How are you doing with water chemistry and quality? A high pH and hardness level are important with GSPs, as well as a specific gravity of at least 1.005, and preferably around the 1.010 mark. Some puffers are sensitive to high nitrates as well, even if the filtration is otherwise adequate.
Internal parasites are always a risk with wild-caught fish. Your list of options here isn't too long. There are some commercially available treatments (e.g. Octozin) for internal parasites, but their effectiveness is variable depending on the parasite in question. Fortunately, serious cases of internal parasite infection are rather rare.
Cheers,
Neale