Weight gain, diabetes, and changes in serum lipid profiles have been reported during treatment with typical and atypical antipsychotics. An association between diabetes and psychotic disorders was described long before the introduction of pharmacological agents for the treatment of schizophrenia. Several theories have been proposed to explain the baseline weight increase and metabolic disturbances in schizophrenia. Some studies suggest that increased food intake may improve psychotic symptoms in patients with schizophrenia but there have been conflicting results. Available clinical and basic research findings are discussed to evaluate the hypothesis that increased food intake may decrease sensitivity to dopamine signaling in the striatum. More research is needed to evaluate this potential link. However, basic animal research and evolutionary approaches can provide insights into metabolic disturbances associated with schizophrenia.