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 vertical sleeve gastrectomy for overall cardiovascular disease risk reduction and risk factor remission, as well as safety in a diverse group of patients (55% racial/ethnic minority). With these aims, the investigators 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. This study continues with manuscript completion.