For many people living with a mental illness, medications are essential as part of a comprehensive care plan to not only alleviate symptoms but also to improve the quality of life and improve function. Unfortunately, for some medications in psychiatry, they have a risk of causing weight gain which is undesirable and understandably a reason why people do not want to begin treatment or stay on the treatment. Fortunately, in many cases, weight gain that is associated with psychiatric medication is preventable by changing diet, lifestyle, sleep patterns and engaging in exercise. In some cases, there are alternative psychiatric medications that are equally effective for select mental illnesses that could be considered if the initial medication prescribed is causing weight gain. In some circumstances, if the medication is really helpful for a mental illness but causes weight gain that is not responding/improving with to diet/lifestyle/behavioral modification, improvement in sleep and exercise, there are new treatment options that clinicians can discuss with their patients. These new treatment options may help reduce the likelihood of gaining weight and should be discussed as part of a shared decision process between the clinician and patient. This article summarizes the field on medication-related weight gain in people with a mental disorder, how to prevent it, and how to treat it.