Schizophrenia is associated with an increased risk of metabolic disorders such as diabetes, dyslipidaemia and the metabolic syndrome. The prevalence of type 2 diabetes in schizophrenic patients is at least twice that of the general population. Around 40 percent of patients meet criteria for the metabolic syndrome. Recently there is a growing concern on the metabolic side effects of treatment with second generation antipsychotics. According to various studies, including a prospective study performed in Flanders, treatment with clozapine and olanzapine has the highest metabolic risk, followed by quetiapine and risperidone. Amisulpride, ziprasidone and aripiprazole appear to have a low metabolic risk. Appropriate care, taking into account the possible improvement of the metabolic risks factors, is important to reduce morbidity and mortality in schizophrenic patients treated with antipsychotic medications.