KNOWLEDGE, PERCEPTION, AND USE OF THE KETOGENIC DIET IN COLLEGE STUDENTS AT A MIDWESTERN UNIVERSITY A thesis submitted to the college of Kent State University College of Education, Health, and Human Services in partial fulfillment of the requirements for the degree of Master of Science By Alexandria M. D’Agostino May 2019 Copyright, 2019 by Alexandria M. D’Agostino All Rights Reserved ii Thesis written by Alexandria M. D’Agostino B.S., Cleveland State University, 2017 M.S., Kent State University, 2019 Approved by _________________________, Director, Master’s Thesis Committee Eun-Jeong Ha ________________________, Member, Master’s Thesis Committee Natalie Caine-Bish _________________________, Member, Master’s Thesis Committee Tanya Falcone Accepted by _________________________, Director, School of Health Sciences Ellen Gleckman _________________________, Dean, College of Education, Health and Human Services James Hannon iii D’AGOSTINO, ALEXANDRIA M.S., May 2019 Nutrition and Dietetics KNOWLEDGE, PERCEPTION, AND USE OF THE KETOGENIC DIET IN COLLEGE STUDENTS AT A MIDWESTERN UNIVERSITY (PAGE 172 pp.) Director of Thesis: Eun-Jeong Ha, Ph.D. The ketogenic diet (KD) as a weight management method continues to gain popularity among college students because of its rapid weight loss results and quick health advantages (Abbasi et al., 2018). Despite the lack of KD knowledge represented among students (N=1,131) in the current study, students continue to engage in unhealthful eating behaviors such as fad diets (FD) (like the KD), thus failing to adopt healthy eating patterns (Pearson & Young, 2008). The purpose of this study was to examine KD knowledge, perception, and use among college students. Participants were limited to male and female students between the ages of 18-26 years who completed an online self-reported survey questionnaire. Results showed 18.1% of students responded to using the KD. Significant differences in KD knowledge were found between health related majors and non-health related majors (p=0.018), and between users and non-users (p= 0.001). Overall, health related majors and users had higher knowledge scores versus non-health related majors and non-users. For perception, results indicated a significant three-way interaction effect between sex, health related major, and users (p=0.026). Within each combination of user and major, male students perceived the KD as favorable than females, except for KD users in non-health related majors, where females had a slightly higher perception than males. Future studies analyzing KD knowledge, perception, and use for weight management long-term are needed to confirm the results of this study. ACKNOWLEDWEMENTS I would like to thank my thesis advisor Dr. Eun-Jeong Ha for her guidance, endless support, and patience throughout this process. Without her encouraging feedback and advice, this study would not have been possible. I would also like to thank my committee members for their continuous support and feedback. Because of my committee members collaborative efforts, I was able to generate an extensive and comprehensive document addressing the ketogenic diet’s current role in weight management. In addition, I would also like to thank Anthony Shreffler and Jordan Pastor over in the Research Bureau in White Hall for their guidance and dedication to my survey development and data analysis. Lastly, I would like to thank my incredible family, friends and fiancé for their unceasing love and support throughout this journey. Thank you for believing in me, and for always reassuring me that I could accomplish anything I set my mind to. iv TABLE OF CONTENTS Page ACKNOWLEDGEMENTS . iv LIST OF FIGURES . x LIST OF TABLES . xi CHAPTER I. INTRODUCTION . 1 Statement of the Problem. 3 Purpose Statement . 4 Hypothesis . 5 Operational Definitions . 5 II. REVIEW OF LITERATURE . 7 Overweight and Obesity . 7 Prevalence in United States . 7 Factors Contributing to Obesity . 9 Genetics . 9 Lifestyle . 14 Dietary Intake . 14 Added-Sugar . 15 Added-Fat . 15 Eating Out . 16 Portion Sizes . 18 Snacking . 19 Physical Activity . 20 Basal Metabolic Rate . 22 Lean Muscle Tissue . 23 Environment . 24 Socioeconomic Status . 24 Geographic Location . 24 Education . 25 Chronic Diseases Related to Overweight and Obesity . 25 v Type II Diabetes . 25 Prevalence . 26 Etiology/Causes/Mechanism . 26 Symptoms . 27 Complications . 27 Prevention & Treatment . 28 Cardiovascular Disease . 29 Prevalence . 29 Etiology/Causes/Mechanism . 30 Symptoms. 30 Complications . 31 Prevention . 31 Treatment . 32 Hypertension . 33 Prevalence . 33 Etiology/Causes/Mechanism . 34 Symptoms . 35 Complications . 35 Prevention. 35 Treatment . 36 Cancer . 37 Prevalence . 38 Etiology/Causes/Mechanism . 38 Symptoms . 40 Complications . 40 Prevention . 41 Treatment . 41 Other Health Outcomes Related to Overweight and Obesity . 43 Rheumatoid Arthritis. 43 Prevalence . 43 Etiology/Causes/Mechanism . 44 Contrasting View . 44 Symptoms . 45 Complications . 45 Prevention . 46 Treatment . 46 Osteoarthritis. 46 Etiology/Causes/Mechanism . 46 vi Symptoms . 47 Complications . 47 Prevention . 47 Treatment . 47 Depression . 48 Prevalence . 48 Etiology/Causes/Mechanism of How Depression May Cause Obesity . 48 Etiology/Causes/Mechanism of How Obesity May Cause Depression . 50 Symptoms . 50 Complications . ..