**5. Conclusions**

Network comparisons provided interesting insight into the most interlinked quality of life domains in patients with obesity and low and high physical performance levels, revealing similar network structures, with Vitality playing a central role among quality of life variables. Moreover, in patients with obesity and low physical performance levels, Mental Health is a central variable, indicating that psychological aspects should be considered in defining quality of life in patients with low physical performance levels. Knowledge of these aspects can provide a useful guide for clinicians, suggesting the use of psychosocial interventions and improving the importance of physical fitness aspects in obesity management, especially in patients with low physical performance. Future studies should contribute to clarifying the relationship between quality of life and physical performance using new statistical approaches, including network analysis. Moreover, well-conducted longitudinal clinical trials and intervention studies should be performed to evaluate the effect of associating strategies to improve mental health on the standard weight management in improving physical fitness and quality of life of patients with obesity.

**Author Contributions:** Conceptualization, R.D.G. and S.C.; data curation, S.C., F.S., A.R., L.D.; formal analysis, S.C.; investigation, R.D.G.; methodology, R.D.G. and S.C.; resources, R.D.G., S.C., F.S., A.R., L.D.; software, S.C.; writing—review and editing, R.D.G., S.C., F.S., A.R., L.D. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Conflicts of Interest:** The authors declare that they are aware of no conflict of interest.
