Obesity and severe obesity have been added to the list of conditions that put children and teens at increased risk for early heart disease.

“Parents need to know that some medical conditions raise the chances of premature heart disease, but we are learning more every day about how lifestyle changes and medical therapies can lower their cardiovascular risk and help these children live their healthiest lives,” Dr. Sarah de Ferranti said in an American Heart Association (AHA) news release. She is chief of the Division of Cardiology Outpatient Services at Boston Children’s Hospital.

Other conditions that increase the risk of early heart disease in children and teens include Type 1 and Type 2 diabetes, familial high cholesterol, congenital heart disease, and surviving childhood cancer.

Severe obesity and obesity are now included as moderate-risk and at-risk conditions, respectively, because research shows they significantly increase the risk of heart disease later in life, according to the AHA.

A study of nearly 2.3 million people who were followed for over 40 years found that the risk of dying from heart disease was two to three times higher if they had been overweight or obese as teens.

In general, a gradual approach to weight loss is required, including healthier eating, fewer calories, more physical activity, meal replacements, drug therapy, and/or weight-loss surgery depending on the severity of obesity.