Despite increases in obesity and related diseases in developing nations, initial refugee clinical visits do not address these issues. We explored the development of obesity and related diseases in a longitudinal prospective cohort of African refugees resettling in northeastern US. Using state Department of Health data, refugees were linked to a health system. Body mass index, diabetes, hypertension, and hyperlipidemia status were extracted from charts. US regional controls from NAMCS/NHAMCS data were matched by age, sex, race, and visit year. African refugee BMI increased after resettlement at 1 (1.7 +/- 2.9, p < 0.0001) and 5 years (3.1 +/- 3.7, p < 0.0001), a different trend than matched regional controls (p = 0.01). Refugees had increased rates of diabetes (1.0 vs. 10.8 %, p < 0.0001), hypertension (16.7 vs. 21.6 %, p < 0.0001) and hyperlipidemia (3.9 vs. 10.8 %, p < 0.0001) at 5 years not observed in regional controls. Our findings emphasize the need for interventions during resettlement to prevent development of obesity and related disease in this vulnerable population.