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Rates of Blount disease and childhood obesity have increased in parallel, although the co-management of this acquired comorbidity and obesity is not well described. This report shares the course of a toddler with severe obesity who experienced rapid and persistent weight gain without success from nutrition and behavior changes. After repeat subspeciality evaluation, the patient was ultimately diagnosed with signs of early-onset Blount disease, urging the need for adjunct medical therapy. Initiation of topiramate was shown to achieve weight neutrality and improve the patient's body mass index (BMI), appearing to halt the progression of Blount disease and avoiding escalation to surgical treatment. This report suggests topiramate can be an effective and well-tolerated medication in young patients with a pressing need for weight intervention.