The Royal College of Physicians launched recommendations today that each NHS Trust should have an obesity champion and that we, as a society, must tackle this epidemic given the predicted levels of obesity in the population. However, the medical profession must tackle their oversight of obesity when it confronts them either among patient populations and perhaps in their own families and communities. Patients in psychiatric care are often placed on psychotropic medication that can significantly increase their weight, but there is significant reluctance to tackle weight gain in order to avoid non-compliance or to negate the impression of coercion or stigma. There are good guidelines now available for clinicians to tackle obesity and these should be more actively used by all clinicians. Yet, this is not enough. Population and public health interventions include education, better information and healthier and affordable food and drinks options, whilst at the same time restricting access in schools and hospitals to unhealthy food and drinks options. These are essential and patients in psychiatric care are entitled to benefit from these approaches, however, they may need more targeted approaches that do not sit comfortably with all public health practitioners. We need to articulate these dilemmas in the culture of care in order to make progress.