Karla walks in from school and drops her backpack on the floor. I open the lunchbox my wife packed this morning. Bell peppers, cucumber, avocado. Biltong, which has become a family favorite since we arrived in South Africa: dried meat, sometimes beef, sometimes ostrich, sometimes game like kudu or springbok. Apple slices and a plum. Dried dates for dessert. More came back than usual. The bell peppers barely touched. The dates gone, obviously.
“I want chips tomorrow. And a KitKat.”
She is six. She says this with the confidence of someone giving a quarterly report to a boardroom.
We’re in Cape Town on sabbatical. Three kids at an international school, new continent, new everything. When we arrived, we did what we always do: packed the same lunches we pack in Berlin, plus the biltong. Vegetables, protein, fruit, real food. It took about three days for the kids to come home with a full report on what the other kids eat. Chips. Sweets. Juice boxes. Things wrapped in plastic with ingredient lists you need a chemistry degree to decode.
“Nobody eats like us,” Karla announced. Magnus, nine, built a case for why we should adapt to local standards. Tilda, twelve, said nothing and rolled her eyes, which at her age is a position statement.
I stood in the kitchen doing what I often do: running the science in my head. Ultra-processed food. Dopaminergic reward pathways. Metabolic programming in middle childhood. Insulin sensitivity. I know what this stuff does. I’ve read the literature. I’m a doctor and a health nerd, and my wife will confirm that the second part is the bigger problem.
None of that makes the veggies more appealing to a six-year-old who just discovered that other kids get KitKats.
I know we live in a bubble. I know that our standards come from privilege and a medical background that most families don’t have. But the metabolic data doesn’t care about your background. What ultra-processed food does to a developing metabolism, it does to every child. The question isn’t whether you can afford to pack better lunches. It’s whether you understand what’s compounding inside that lunchbox every single day.
Standing in that kitchen, watching my three kids run their own lobbying campaigns for processed food, I kept thinking about this. I’m not packing lunches. Not really. I’m managing a portfolio. One that will run longer than any career, any fund, any strategy I’ll ever touch.
The Market Conditions
Here’s what Cape Town taught me that Berlin couldn’t.
In Berlin, food culture is better. Whole-grain bread everywhere. Good produce. Less processed snacking as a default. On paper, Berlin wins the nutrition round.
But try getting your kid into a sports club in Berlin. When Magnus was five, we wanted him in a football club. Just football. A boy who wants to run around and kick a ball. He went through a four-week assessment period, probation-style, attending practice sessions while the coaches evaluated him. After four weeks, they declined him. The reason: “He’s not good enough.”
He was five.
Come on. You can’t be serious. But this was not unusual. Hockey, basketball, tennis: the same thing happens everywhere in Berlin. There are not enough spots for something as simple as letting a child move. It makes you think about leaving.
Cape Town flipped the script. Sport is woven into the school day. The options are everywhere. My kids have more access to physical activity here in two months than they had in two years of navigating Berlin’s sports infrastructure.
But then you look at the lunchboxes.
Neither city does all four foundations well. Berlin has food. Cape Town has movement. You can’t move to the perfect environment. You have to build the portfolio wherever you are.
The Four Asset Classes
This sits in the Activate pillar of my Upward ARC framework. Sleep, movement, nutrition: the daily inputs that determine whether your body builds or breaks down. I write about this for executives. For your kids, the math runs the same way. Except that the holding period isn’t the next quarter. It’s 80 years. And hopefully many more.
Childhood health behaviors track into adulthood with surprising fidelity. What happens between ages 6 and 12 sets a trajectory that becomes progressively harder to redirect. After 15, identity and peer influence take over. The window is now.
Sleep is the bond portfolio. Boring. Essential. Compounds quietly.
Children aged 6 to 12 need 9 to 12 hours per night [1]. Most get less. Poor childhood sleep predicts adolescent depression, increased risk-taking, and adult cardiovascular disease markers [2]. Sleep problems track at r=0.40, meaning a child who sleeps poorly at 8 is significantly more likely to sleep poorly at 15 [3]. Fragmented sleep is worse than short sleep because it interrupts slow-wave cycles, the same glymphatic clearance process I’ve written about for adults [4].
Tilda knows all of this. I have explained melatonin suppression to her. She nodded and seemed to understand. Still, I am pretty sure she scrolls under the covers anyway. She is twelve, in the middle of puberty, and knows that if she waits until we close our door, we will not check. At this age, strict rules do not work. If you push too hard, she will find a way around it. So you change the environment. Screens charge in the kitchen. The bedroom stays dark. The boundary is not a discussion. It is built into the room.
Movement is the growth equity. High returns. Needs early investment.
Organized sport participation tracks from childhood to adulthood at r=0.40 to 0.60 [5]. General physical activity? r=0.14 [5]. Barely a signal. The mechanism: motor competence builds confidence, confidence builds preference. A kid who can throw, run, and swim wants to keep doing it. A kid who can’t, avoids it. That avoidance compounds.
This is why I am still upset about what happened with Magnus. A five-year-old does not need to be ‘good enough’ for organized sport. He just needs to move. He needs to build the basic skills that will decide if he is active at 25 or not. The WHO says children should get 60 minutes of moderate to vigorous activity each day [6]. Doing more than that does not add much, but doing less adds up quickly in a bad way. Berlin’s sports system almost kept my son from the most important health habit for kids. In Cape Town, he gets it easily.
Nutrition is the inflation hedge. Protects against slow erosion you don’t feel until it’s too late.
School-age children derive 47-59% of their daily calories from ultra-processed foods [7]. Not a single study has reported a beneficial health outcome from higher ultra-processed food intake [7]. Not one. Higher consumption tracks with obesity, metabolic dysfunction, disrupted gut microbiota, and depressive symptoms [7][8].
Food preferences form through repeated exposure (15-20 times) and parental modeling [9]. Not lectures. Not sitting your daughter down and explaining food science while she stares at you with the dead eyes of someone who asked for chips and got a TED talk. Kids eat what they see their parents eat and what’s available in the house. Restriction backfires [9]. Pressure backfires. The only approach with evidence: control what’s available, model eating it yourself, and let the child decide how much.
That lunchbox with the bell peppers and biltong? It’s not a meal. It’s metabolic programming. Every day.
Stress regulation is the insurance policy. You don’t notice it until you need it.
Your children mirror your stress response. Not your advice about stress. Your actual response. When parents are chronically stressed, their HPA axis (the hypothalamic-pituitary-adrenal axis, your body’s central stress regulation system) becomes dysregulated. That dysregulation transmits to children through measurable biological pathways, including DNA methylation changes at glucocorticoid receptor genes [10]. In plain terms: your chronic stress literally changes how your child’s genes express themselves.
Parents who use cognitive reappraisal (reframing threat as challenge) have children who develop the same strategies [11]. Parents who avoid or suppress have children who do the same. You can’t hide chronic stress from a twelve-year-old. Tilda understands my physiology better than most of the colleagues I’ve worked with. She knows when I’m tense before I do. She calibrates her behavior to my state, not to my words.
The protective factor isn’t zero stress. It’s visible regulation. My wife does yoga every day. The kids see it. I work out before they wake up. They know it. We take walks to clear our heads, and we tell them that’s why we’re walking. They’ve tried breathwork with us. We choose nature over screens when we need to reset. They don’t do this because we explained the neuroscience. They do it because they’ve watched us do it a thousand times.
Most parents focus too much on one area. ‘We eat clean.’ That is good, but do the kids get 10 hours of sleep? ‘They play sports every day.’ That is good, but what do they eat for lunch? The numbers do not lie: two areas at 90 percent and two at zero is worse than all four at 70 percent. Putting all your effort into one part of health is as risky as putting all your money in one investment. Do not do that with your kids’ health.
Why Knowing the Science Makes You Worse at This
Health-literate parents default to explanation. You describe what happens when they eat sugar. You walk through sleep architecture. You offer choices. You treat your kids like small executives who will make rational decisions given sufficient information.
The research says the opposite: children aged 6 to 12 benefit more from designed structure than from explanation and choice [9][12]. Choice, in the presence of ultra-processed options, actually worsens eating patterns [9]. I learned this the hard way. You can negotiate with Magnus about food choices, give him options, and explain the trade-offs. He’ll listen, nod, and select whatever has the most sugar. Not because he’s irrational. Because he’s nine, and the dopaminergic pull of hyperpalatable food will beat a rational argument every time. Structure first. Explanation later. Maybe never.
The same pattern shows up everywhere once you see it. You think your stress is compartmentalized because you don’t yell at dinner. But stress isn’t something you perform or don’t perform. It’s physiological. Your HPA axis is running hot, and your children’s cortisol levels are responding to yours, whether you raise your voice or not [10]. The instinct is to hide it. To push through. To compartmentalize as you do at work. Except the people you live with aren’t colleagues who see you for eight hours. They’re sponges that absorb your baseline state 24 hours a day.
Then there is the sprint problem. You try for a perfect month of sleep routines, but it falls apart when work gets busy. You start a family dinner habit, but it stops when you travel. You buy healthy food, but after a few weeks, the snacks come back because someone had a hard week. Health does not reward short bursts of perfection. It rewards being steady at 70 percent. A child who sleeps 8 hours five nights and 6 hours two nights does worse than a child who sleeps 7.5 hours every night [13]. The ups and downs are the problem, not the average.
The temptation for people like us is to reach for advanced tools: cold plunges, supplements, specialized coaching for our kids. But you cannot supplement your way around a pantry full of processed food. The basics still outperform the optimization. Every time.
Try This Today
Rebalance the Pantry. This week, remove one category of ultra-processed food from the house. Chips, sugary cereal, juice boxes, pick one. Don’t announce it. Don’t explain. Just do it. Replace with something at the same accessibility level: fruit bowl on the counter, nuts in the snack drawer, cut vegetables at eye level in the fridge. Environment design beats willpower, in adults and in children [9][12]. If it’s not in the house, nobody negotiates for it. Karla can’t demand a KitKat that doesn’t exist.
Set the Bedtime Floor. Non-negotiable. Within a 30-minute window, six nights a week. Screens out of bedrooms, charging in a common area. No screens 60 minutes before bed. Behavioral sleep interventions reduce sleep onset latency by 9-19 minutes [14]. Expect 7 to 10 nights of resistance. Hold it. And for the Tildas in your house, the ones old enough to game the system: design the environment so the default is compliance. Screens in the kitchen. Dark bedroom. The boundary isn’t a rule to enforce. It’s a room with no temptation in it.
Fund Movement. Ask your kid what they want to try. Not what you think they should do. Organized sport is the single highest-tracking health behavior from childhood to adulthood (r=0.40-0.60) [5], but total daily movement matters too. Aim for 60 minutes of activity per day across everything: the sport, the bike ride to school, the run around the garden, the walk with the family. Let the organized activity anchor the week, and let the rest fill in naturally. And if a club tells your five-year-old he’s “not good enough,” find a different club. Or a different city.
Make Your Stress Visible. Pick one strategy that takes under 5 minutes: a walk, breathing, or naming the emotion. Use it in front of your kids when you’re actually stressed. “I’m frustrated. I need a walk.” Walk. Come back. Don’t explain. Don’t make it a lesson. Three to five times a week. Your children will mirror what they see, not what they’re told [11]. This isn’t parenting advice. It’s biology.
The 80-Year Portfolio
Your career will end. Your job title will be forgotten. The strategy decks you’re proud of will be archived and never reopened.
But the health account you’re building in your children right now, that one runs for 80 years. And hopefully many more.
Every lunchbox is a deposit. Every bedtime is a deposit. Every time they watch you take a walk instead of losing your temper, that’s a deposit too. And every bag of chips, every screen glowing past midnight, every time they see you white-knuckle through stress without a single visible coping strategy… those are withdrawals.
The returns won’t show for decades. The metabolic panel at 40. The stress resilience at 35. The relationship with movement at 50. You won’t see all of it. That’s the point.
Karla will ask for chips again tomorrow. She will make her case with the conviction of someone who has never lost a negotiation, because she hasn’t. Magnus will test whatever boundary we set, figure out where it bends, and use that information against us. Tilda will say nothing, find a workaround behind our backs, and look genuinely puzzled when we ask about it.
The portfolio doesn’t require perfection. It requires consistency. The same deposits, made repeatedly, over years.
In three generations, no one will remember you. But the foundations you built into your children’s daily rhythms? Those compound. Across decades. Across generations. Long after the lunchbox arguments are forgotten, the bedtime negotiations are a family joke, and the kids have kids of their own who refuse to eat their vegetables.
The best investments outlast the investor.
Stay healthy.
Andre
References
[1] American Academy of Sleep Medicine. (2016). Recommended amount of sleep for pediatric populations: A consensus statement. Journal of Clinical Sleep Medicine, 12(6), 785-786.
[2] Owens, J. A. (2014). Insufficient sleep in adolescents and young adults: An update on causes and consequences. Pediatrics, 134(3), e921-e932.
[3] Gregory, A. M., & O’Connor, T. G. (2002). Sleep problems in childhood: A longitudinal study of developmental change and association with behavioral problems. Journal of the American Academy of Child & Adolescent Psychiatry, 41(8), 964-971.
[4] Xie, L., Kang, H., Xu, Q., et al. (2013). Sleep drives metabolite clearance from the adult brain. Science, 342(6156), 373-377.
[5] Garcia-Hermoso, A., Ramirez-Campillo, R., & Izquierdo, M. (2022). Tracking of physical fitness levels from childhood and adolescence to adulthood: A systematic review and meta-analysis. Translational Pediatrics, 11(3), 474-486.
[6] World Health Organization. (2020). WHO guidelines on physical activity and sedentary behaviour. Geneva: WHO Press.
[7] Monteiro, C. A., Cannon, G., Lawrence, M., Costa Louzada, M. L., & Pereira Machado, P. (2019). Ultra-processed foods, diet quality, and health using the NOVA classification system. Rome: FAO.
[8] Pagliai, G., Dinu, M., Madarena, M. P., Bonaccio, M., Iacoviello, L., & Sofi, F. (2021). Consumption of ultra-processed foods and health status: A systematic review and meta-analysis. British Journal of Nutrition, 125(3), 308-318.
[9] Birch, L. L., & Fisher, J. O. (1998). Development of eating behaviors among children and adolescents. Pediatrics, 101(S2), 539-549.
[10] Qi, X., & Yu, Y. (2022). Parental stress transmission in children: Mechanisms, assessment, and intervention. Frontiers in Psychiatry, 13, 991423.
[11] Eisenberg, N., Cumberland, A., & Spinrad, T. L. (1998). Parental socialization of emotion. Psychological Inquiry, 9(4), 241-273.
[12] Wood, W., & Neal, D. T. (2016). Healthy through habit: Interventions for initiating and maintaining health behavior change. Behavioral Science and Policy, 2(1), 71-83.
[13] Tremblay, M. S., Carson, V., Chaput, J. P., et al. (2016). Canadian 24-hour movement guidelines for children and youth. Applied Physiology, Nutrition, and Metabolism, 41(6), S311-S327.
[14] Mindell, J. A., Kuhn, B., Lewin, D. S., Meltzer, L. J., & Sadeh, A. (2006). Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep, 29(10), 1263-1276.
A note for new readers:
I’m a trained reconstructive facial surgeon, medical doctor, and dentist. Before launching this newsletter, I had a varied career: competitive freestyle wrestler, management consultant (McKinsey), entrepreneur (Zocdoc, Thermondo, and docdre ventures), and corporate executive (Sandoz). Today, I’m a Managing Director and Partner at BCG.
Husband of one. Father of three. Split between Berlin’s urban pulse and our Baltic Sea retreat. I’d rather be moving than sitting. Not just hobbies. Research. My body is my primary laboratory; I’ve been conducting experiments for decades.
If this is your first time here, welcome. I’m excited to share what I’ve learned and will continue to learn with you.
DISCLAIMER:
Let’s get one thing straight: None of this, whether text, graphics, images, or anything else, is medical or health advice. This newsletter is here to inform, educate, and (hopefully) entertain you, not to diagnose or treat you.
Yes, I’m a trained medical doctor and dentist. No, I’m not your doctor. The content here isn’t a replacement for professional medical advice, diagnosis, or treatment.
If you have questions about your health, talk to your physician or a qualified health professional. Don’t ignore their advice or delay getting care because of something you read in The Upward ARC. Be smart. Do your research. And, as always, take care of yourself.
Once I learned of the dire consequences of ultraprocessed food, I slowly stopped buying it. I simply told my kids the store didn’t have it anymore. When they got older and started shopping for themselves I heard about all the ultraprocessed food the store still carries! But by then they didn’t want it. Also, the Yuka app for scanning the bar codes on processed foods is a nice tool. Your kids might enjoy using it.