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For those with severe obesity or weight-related comorbidities, referral to Tier 3 or Tier 4 weight management services may be appropriate, which could include consideration of bariatric surgery according to NICE criteria (CG189)

Notably, a marginal increase in risk (RR 1.34, 95% CI 1.04, 1.72) was observed in studies with methodological flaws 41

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