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The nutrition and eating habits of women in a secure psychiatric service were surveyed using in vivo participation, observation and self‐report procedures. It was predicted that high levels of obesity were partly related to unhealthy eating preferences, over‐consumption of food and environmental factors that supported an unhealthy lifestyle. The results indicated an obesogenic environment in which patients made unhealthy food choices to supplement meals. Post‐survey initiatives have led to increased satisfaction with a healthier and more palatable diet and proactive attempts to help patients engage with a therapeutic and healthier lifestyle to address obesity. The importance of environmental change, education and motivational strategies to engage patients is highlighted.