The recognition that schizophrenia is associated with metabolic comorbidity and a subsequent greater risk of cardiovascular events compared to the general population has led to attempts to reduce this metabolic burden. Increased weight, and smoking rates combined with less exercise and poor dietary choices, have led to a variety of behavioural programmes and pharmacological agents being evaluated with the aim of improving lifestyle and managing weight. Adjunctive pharmacological strategies for weight management have not been shown to be consistently effective and remain contraindicated in many schizophrenia subjects. However some novel compounds with recent promising data suggest that research should not be abandoned. In contrast a variety of behavioural interventions have shown a consistent degree of success not only with weight management but also in achieving lifestyle changes. Many reported data-sets are naturalistic or open-label indicating that there is a difficulty in performing traditional randomized controlled studies in this area. The long-term naturalistic studies and holistic approaches show that weight management and significant lifestyle changes are attainable goals in schizophrenia patients. Weight management and lifestyle advice should be routinely offered to all schizophrenia subjects.