We thank Smith et al. for the publication of a metformin prescribing tool1 for people with severe mental disorders (SMD). The importance of physical health in people with SMD is now well recognised.2 Even though there is evidence to suggest that the rate of screening people with SMD for metabolic issues in Australia outperforms the international average, the rate of intervention still lags behind that of identification,3 with physical ill health among those with SMD often under-diagnosed.4 A practical tool to facilitate secondary prevention by limiting antipsychotic associated weight gain is of clear relevance to psychiatry.