Metabolic abnormalities have consistently been identified as a part of schizophrenic illness, but with the introduction of second-generation antipsychotics and their possible association with metabolic abnormalities, the interest in this topic has been renewed. Many studies have now provided convincing evidence for a high risk of obesity, diabetes and other glucose abnormalities, the metabolic syndrome, and mortality due to elevated cardiovascular risk in patients with schizophrenia. These metabolic abnormalities are of major clinical concern, not only because of their direct, somatic effects on morbidity and mortality, but also because of their association with psychiatric outcome, such as a higher prevalence of psychotic and depressive symptoms, a lower functional outcome, a worse perceived physical health and lower adherence to medication. The reasons that underlie the high prevalence of these metabolic abnormalities are much debated, especially when considering the possible role of second-generation, 'atypical' antipsychotics in the occurrence of these abnormalities. Many studies have suggested a role of (certain) atypical antipsychotics in the occurrence of metabolic abnormalities; case reports, cross-sectional or retrospective studies and prospective studies. Different consensus groups have proposed guidelines for screening, monitoring and management of metabolic abnormalities for people treated with antipsychotic agents.