Atypical antipsychotics can also cause a patient to enter the metabolic highway via another entrance ramp, namely through the direct production of atherogenic dyslipidemia, including elevated fasting triglyceride levels and low serum high-density lipoprotein (HDL) cholesterol even in the absence of weight gain or obesity (Fig. 1). The pattern of low HDL and high fasting triglycerides is strongly associated with insulin resistance. In patients with genetic vulnerability, the compensatory hyperinsulinemia demanded by insulin resistance can eventually proceed to pancreatic b-cell failure, prediabetes and then type II diabetes. This highway intersects with the path of obesity, where