High-quality systematic review of 24 RCTs (45,660 participants) with moderate certainty evidence on long-term hormone therapy effects across multiple clinical outcomes; primarily powered by two well-conducted large trials (HERS, WHI) with low risk of bias.
A rigorous network meta-analysis of 18 studies (13 RCTs, 5 cohort studies) with 15,282 participants using GRADE certainty assessment, showing consistent but imprecise evidence that RYGB, OAGB, and SG improve weight loss, waist circumference, and glycaemic control versus lifestyle/medical treatment in adults with obesity and type 2 diabetes.