It is a firm belief in the battle against cellulite: lose weight and you will help rid yourself of the"orange peel" effect. But research published yesterday suggested that calorie-counting and chocolate denial – far from improving the situation – could make cellulite worse for some.

Women who were significantly overweight looked better after losing a lot of extra fat. But it was women who had less of a problem who were most at risk of exacerbating the problem.

The research, published in Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons, is based on a study of 29 women who enrolled in medically supervised weight loss programmes. These included low-fat meals and the extreme measure of bariatric surgery, such as gastric bypass and gastric banding. Seventeen of these patients (58%) experienced an improvement in the appearance of their cellulite, but nine (31%) saw their condition worsen.

The patients with the biggest improvements were those who lost the most weight and lowered their percentage of thigh fat. They also had a higher body mass index (BMI) to begin with and more severe cellulite.

Patients whose cellulite worsened started with a "significantly" lower BMI, lost smaller amounts of weight and had no change in percentage of thigh fat.

Those whose skin became looser after weight loss – losing its elasticity – also had worse cellulite. The average weight loss was 13.8kg (30.5lb). The study concluded that losing weight had "variable effects" on the appearance of cellulite.

John Kitzmiller, a plastic surgeon and co-author of the study, said: "Approximately 85% of women are affected by cellulite. Cellulite is not specific to overweight people but excess weight may worsen the condition.

"Although the appearance of cellulite diminished for the majority of patients, weight loss did not totally eradicate the condition. The dimples appear to be permanent features that lessen in depth as the pounds come off."

Simon Withey, a consultant plastic surgeon with London Plastic Surgery Associates, said the study appeared to indicate that skin elasticity played a role in the appearance of cellulite. He added that the distinctive dimply appearance could affect even slim women. "Everyone is slightly different in the way cellulite affects them. Some people get it because they’re overweight; some people are genetically predisposed," he said.
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