This study assessed the association between baseline sociodemographic variables, body composition and 4-year changes in the intake of food groups, including sugar-sweetened beverages (SSB) among children, after the implementation of the health promotion levy.

Prospective cohort study.

Ten schools in North West Province, South Africa.

950 children aged 5–9 years at baseline and data of 672 children at follow-up. The frequency of intake from healthy and unhealthy food groups was assessed by questionnaire. Anthropometric and sociodemographic information were collected; BMI-for-age z-scores were calculated. The health promotion levy was implemented after baseline and follow-up measurements were done after 4 years. A random intercept generalised linear mixed model analysis was applied to investigate the time effect of the weekly intake of the foods adjusting for BMI-for-age z-scores and sociodemographic characteristics of the children.

The weekly frequency of intake from most food groups remained unchanged at follow-up. The frequency of SSB intake decreased significantly over 4 years. Decreased intake of SSB was not linked to increased intake of healthy foods. Changes in intakes from SSB were not associated with household income, parental education or BMI-for-age z-score categories. A decreased frequency of intake from SSB was observed following the implementation of the health promotion levy after baseline, in line with reports of national decreases in SSB sales in South Africa since 2017.

The decreased frequency of SSB intakes following the implementation of the health promotion levy in South Africa may indicate that health policies can promote healthier dietary habits.