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That definitely wasn’t true when I developed my watch face (https://github.com/kelnage/digital-simplicity) - the Garmin IDE compiled it down to a single IQ file which can then be transferred directly to the device via USB.
Of course if you want to distribute it via their App Store you have to apply (it was free when I did it), and the way changing settings used to work (through a convoluted path on the connected mobile device and via the store) it was often best to do that. But you could also use the settings file software Garmin included in their IDE to do it (or now do it directly on the device).