The goal of the proposed study is to provide population-based, comprehensive, rigorous evidence for both clinical and policy decision-making; informing the choice between RYGB and VSG for overall CVD risk reduction and risk factor remission, as well as safety in a diverse group of patients (55% racial/ethnic minority). With our aims we will be able to provide recommendations to providers and patients about the decision between procedures, and help prioritize future health policy decisions and research investments in this area.