Overweight and decreased physical fitness are highly prevalent in schizophrenia, represent a major risk factor for cardio-vascular diseases and decrease the patients' life expectancies. It is thus important to understand the underlying mechanisms that link psychopathology and weight gain. We hypothesize that the dopaminergic reward system plays an important role in this. Methods: We analyzed the seed-based functional connectivity (FC) of the ventral tegmental area (VTA) in a group of

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... ic patients (n = 32) and age- as well as gender matched healthy controls (n = 27). We then correlated the resting-state results with physical fitness parameters, obtained in a fitness test, and psychopathology. Results: The seed-based connectivity analysis revealed decreased functional connections between the VTA and the anterior cingulate cortex (ACC), as well as the dorsolateral prefrontal cortex and increased functional connectivity between the VTA and the middle temporal gyrus in patients compared to healthy controls. The decreased FC between the VTA and the ACC of the patient group could further be associated with increased body fat and negatively correlated with the overall physical fitness. We found no significant correlations with psychopathology. Conclusion: Although we did not find significant correlations with psychopathology, we could link decreased physical fitness and high body fat with dysconnectivity between the VTA and the ACC in schizophrenia. These findings demonstrate that a dysregulated reward system is not just responsible for symptomatology in schizophrenia but is also involved in comorbidities and could pave the way for future lifestyle therapy interventions.