1. the time is equal to 1 to 1 one minute real time is one minute game time .
2 you must drink water ever day or die and after 12 hrs you get permanently dizzy till you do drink . The same goes for food every three days .
3. I would remove 95 % of all food in the game to make it harder to find
4. I would remove 99% of all ammo in the game because in 200 years PA in the future they are not going to have the ability to make modern gun powder , primers , casings ,and bullets at best they will have flint lock style black powder type weapons and bows, cross bows, and spears , that 's it other than mele weapons and perhaps homemade flame throwers .
5. Clothes would be harder to find Only found on other humans and shoes would be the number one item needed
6. weather would affect you cold hot rain you would have to shelter and sleep ( you could compress time )
7. More cannibals lots more lots and lots more .
8. The ability to make weapons and gear would be vital like cutting enemy arrows shot from a bow and making them cross bow arrows giant rad scorpion armor
9 .Dark should be dark a building should have power unless it's got a power source . the middle of the desert should be dark and to dangerous to cross at night even with a flashlight .
10 If New Vegas was missed by the bombs why then is everything around it exactly the same as ground zero Washington DC ? all water should not be irradiated.
So what do you think how could NV be more realistic ?