I hadn't thought of that - that's an intriguing idea.
Myself, I enjoyed hardcoe mode in New Vegas, but more for the elements outside of the scope of the thirst and hunger meters. I liked the different take on healing and inventory weight - but in a game where I'm finding more than enough food and water anyway, I found maintaining my meters more tedious than anything. This has come up before, but I'm still a proponent of the idea that just working on what food and drink do is a better "replacement" for the meters than anything else.
In Fallout 3, I got a nice little XP buff if I was Well Rested - I found that was more than enough incentive to find places to sleep every once in a while. I wasn't penalized if I just simply got too absorbed in the game exploring and playing to rest up - instead there was a game mechanic that encouraged that gameplay anyway. I still think that if Stimpaks were something kind of rare and valuable that you'd save for crisis situations and food and water were something you used to "top off" your HP in between battles, that just with that slight change you've already solved that problem. (This is kind of how I approach the game anyway - but then of course you end up with a stockpile of tons of spare Stimpaks.)
In most of my time playing both New Vegas and Fallout 3, I'd collect food and water as I went along and used those to top off. So I was already eating and drinking more than enough that I never had to worry about what the hardcoe meters were doing in New Vegas - it just became tedious when I would "have" to eat and drink. It didn't bring any added challenge to the table, basically. I think i'd rather just have a nice "Well Fed" buff or something (if we even needed more mechanics,) rather than a food meter.
But I do like the idea about tieing something into settlements. We don't know much about how those work - I think there were hints that you could attract people to your settlement through what you build and how you maintain your settlement, so it's possible there may be some degree of resource-balancing in there as well.