Iván López-Ibor, Hugh Humphery, Gustavo Tafet
People with schizophrenia experience markedly reduced life expectancy, driven largely by cardiometabolic disease, and several of the most effective antipsychotics are also among those most likely to promote weight gain. Weight gain is among the adverse effects patients find least acceptable and one they frequently cite when they abandon treatment, which links metabolic harm directly to the non-adherence that precipitates relapse. Glucagon-like peptide-1 receptor agonists, now supported by randomized trials in schizophrenia-spectrum populations, reduce weight and metabolic burden without destabilizing psychiatric symptoms. In this editorial, we argue that their most consequential effect in serious mental illness may not be the weight they remove but the treatment they help patients keep taking: by neutralizing the adverse effect patients most resent, these agents may protect antipsychotic adherence itself. We call for trials that adopt adherence and discontinuation as endpoints and for psychiatry to reclaim ownership of cardiometabolic prescribing.