OBJECTIVE: Newer antipsychotics have been associated with increased weight gain. There is also mounting evidence that this leads to noncompliance and a lower quality of life. Gaining weight is also undesirable for health reasons and may lead to increased use of health-care resources. This study considers the association between weight gain and acute service use for patients with schizophrenia. METHODS: Questionnaires were mailed to people with schizophrenia identified through National Alliance for the Mentally Ill and the National Mental Health Association in spring 2000 (n = 390). Data presented here are from the 345 respondents who reported weight loss (n = 94, 27%), no weight change (n = 106, 31%), some weight gain (1-14lbs; n = 70, 20%), and significant weight gain (?15lbs; n = 75, 22%) within the last six months. Acute service use was defined as emergency room (ER) visit or hospitalization. Cost values were those reported in Ernst and Hay (1994). For each individual, total costs were computed by summing across categories. RESULTS: The group reporting significant weight gain was significantly more likely to use acute services than the other three groups (p < .001 for hospitalization, p < .005 for ER visit). The association remained significant when controlling for other variables in multivariate analyses, including age, gender, ethnicity, and overall distress. Overall costs were highest for those who gained 15 or more pounds ($9,486). Those who lost weight incurred costs of $7,400, those who did not change weight incurred costs of $4,095, and those who gained 1-14 pounds incurred costs of $3,647. DISCUSSION: Our preliminary results suggest that recent weight gain is associated with greater use of acute services and higher costs. There are several plausible explanations. For example, physicians might change medications for people doing poorly (e.g., start a new medication after an acute psychiatric episode). Another possibility is that acute medical services are more likely to be needed after an episode of rapid weight gain. Quality of Life