I used to work for a large publisher a few years ago.
When a game is in development, you submit a build as close to the final product as possible, along with a list of everything that could be attributed to the game's rating.
ESRB then reviews the build, notes every single instance of nudity, violence against humans/animals/beasts, drugs, etc.. and then gets back to the publisher with what rating will be attached to the game at the state it was submitted to them. Publishers are then 100% in control of any changes they choose to make to the title in order to keep, increase, or decrease the rating given, assuming they want to pay for another submission to the ESRB.
Any changes made to the game were the publisher's decision. ESRB does not force anything other than the rating that goes with the finished product-which the publisher agrees on.
When a game is in development, you submit a build as close to the final product as possible, along with a list of everything that could be attributed to the game's rating.
ESRB then reviews the build, notes every single instance of nudity, violence against humans/animals/beasts, drugs, etc.. and then gets back to the publisher with what rating will be attached to the game at the state it was submitted to them. Publishers are then 100% in control of any changes they choose to make to the title in order to keep, increase, or decrease the rating given, assuming they want to pay for another submission to the ESRB.
Any changes made to the game were the publisher's decision. ESRB does not force anything other than the rating that goes with the finished product-which the publisher agrees on.