I enjoy difficulty changes that make the game more strategic, not more routinary. In the end I disabled the eat sleep drink aspect and I enjoy it more that way because one thing I really like about it is the ammo weight aspect because it means I need to plan exactly the weaponry I'll take with me and how much ammo I'll need or I'll be in deep deep trouble. There's a few mods that mitigate this (mojave wildlife/raiders) but it's still not quite enough for me, not so far anyway since I only just started using those. I use Project Nevada with Realistic Weapons Damage. If you cannot give a rats ass about lore, you can try out Angel Park. The Walking Dead - Makes ghouls walk, among other things.

Maybe I'll install a mod to turn it off and try it out, but at the same time, the game isn't dynamic enough to make trudging thru the same areas over and over again interesting, all the real danger is basically concentrated in spots and if you just avoid them you're good. Project Nevada is probably one of the more well known mods that deals with tweaking game mechanics that makes the game a tad more difficult. Realistic Weapons Damage - RWD - Increases BodyPart Damage, headshots are now Fatal and combat is much more dangerous. It's more interesting if you place a self-imposed restriction of not using fast travel, but I have shitty OCD so I've never been good at restricting myself in that way. Once you setup a base of operations, all it really ends up doing is encouraging you to fast travel back and forth between your base and wherever you are.

Finding food, water and a bed isn't hard, especially the latter two (There's the goodsprings source which has a bed and an infinite source of clean water that you can drink from closeby, not to mention the Lucky 38 which gives you an owned bed and a sink with clean water).

Fnv realistic weapon damage