As someone who usually likes to be as self reliant as possible (I always picked Armourer and Restoration in Oblvion) I was a bit sceptical. I started with it just to get the achievement and say I'd tried it. I'm actually loving it now. At first I was forever panicking about it, but the more you play the better a feel you get for it. They are honestly mild annoyances, but they're just enough to remind you that this is a hostile wasteland. I almost never tier one levels of H20, FOD, or SLP, but the way things affect over time, and how food is more effective at reducing those hardcoe levels with a high Survival skill is good. It certainly makes the game more interesting if you like immersion, not just bang-bang, moneyz, lol headshot.