We determined the impact of 69 African refugee children's arrival age and weight on subsequent weight gain by following BMI of refugee children. During 6-24 months after arrival in the U.S., 57% of underweight children became normal weight, whereas only 2% of normal weight children moved to the next higher weight category (p<.001). Children with overweight or those at-risk for overweight on arrival were more likely to be overweight on follow-up than were children who were not at risk or overweight on arrival (OR 18.9, 95% CI 3.2-112) Despite the tendency of catch-up weight gain of children underweight at arrival, BMI at arrival did not predict the slope of BMI change over time. Children who are overweight at arrival are more likely to remain at risk of overweight. The younger cohort experienced an increase in BMI at a slower rate than the older cohorts.