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NBME 22 Answers
An 8-year-old boy is brought to the physician by ...
Calorie consumption that exceeds energy expenditure
That's a modern day mystery.
The prompt is only asking "what's the likely cause of obesity?" It's not that they're "allowing" him to eat more than exercise. (Few parents can monitor their kids that closely!) The prompt is only asking what's the most likely explanation for his 95th percentile weight and BMI (given that he otherwise appears normal); in the United States, the most likely explanation is eating way more than you expend.
aka 'merica #firstworldproblems