Inclusion Criteria:  Adults (age 18-75 years at index clinical encounter) Existing diagnosis of T2DM BMI ≥35 kg/m2 at index clinical encounter Have an index clinical encounter with a PCC (family practice or general internal medicine physician, nurse practitioner, or physician assistant) at a randomized study clinic during a 12-month accrual period  Exclusion Criteria:  Prior MBS Patients diagnosed with cancer (except non-melanoma skin cancer), dementia, and/or cirrhosis. Pregnant or breastfeeding. In long-term care, palliative care, or hospice care.