Obesity is an increasing global problem. Individuals with severe mental illness (SMI) are no exception; on the contrary, these patients are more often obese than others and suffer from sequelae. Poor life style, poor socio-economic status and side effects to antipsychotics are well known contributors to obesity. Interventions targeting the individual have been tested with limited success. The healthcare systems and the communities have to rethink the integration of individuals with SMI as equal citizens in the society in order to prevent weight gain or for weight loss interventions to be successful.