Schizophrenia is a chronic and debilitating brain disorder. It is associated with increased mortality, primarily due to elevated cardio-metabolic risk. Affected patients have higher rates of obesity, metabolic syndrome and diabetes . Intrinsic factors contributing to this increased risk include a shared underlying pathophysiology between schizophrenia and diabetes mellitus involving stress, inflammation and genetics. Extrinsic contributing factors include diet, lifestyle, health care access, low socioeconomic status and overburden of traditional diabetes risk factors. Antipsychotics are associated with an increased risk of obesity, metabolic syndrome and diabetes mellitus . Appetite-regulating hormones, pharmacodynamics and alterations in glucose metabolism may underlie the negative effect of these medications. Reduction in diabetes risk is achieved by mitigating traditional risk factors. Non-pharmacologic and pharmacologic approaches to cardio-metabolic risk reduction may be helpful in these patients.