Here's a few mods for people interested(personally wanderers addition was a nice try for a mod that upped the difficulty with a food and water system but it stripped away the difficulty and screwed up the balance).
This one is a call of duty realism mod that ups the difficulty and makes you really work to survive combat while changing the combat somewhat.
http://www.fallout3nexus.com/downloads/file.php?id=9331
Primary needs Adds physiological needs (Sleep, Food, Water) to the game along with other things to make the wasteland feel more real.
http://www.fallout3nexus.com/downloads/file.php?id=2125
Just in case you don't want the call of duty mod then here's a few mods that the call of duty recommends that you'll like.
**Combat Enhanced-Tactics**
http://www.fallout3nexus.com/downloads/file.php?id=6492
Enhances AI and gives combat a sense of realism in terms of having enemies take cover along with a slew of other great additions!
**Sprint**
http://www.fallout3nexus.com/downloads/file.php?id=1854
Adds a sprinting feature that scales with your endurance and agility, comes with two additional perks, "Tackle" and "Charge!"
**Iron Sights** (Work In Progress)
http://www.fallout3nexus.com/downloads/file.php?id=6938
Adds iron sights to the game, load this mod after my mod. also when downloading his DLC iron sights mod make sure to use his BASIC version ONLY as his elite version will conflict with my mod.
**Amplified Crippled Effects** (Use Pain Incarnate!)
http://www.fallout3nexus.com/downloads/file.php?id=85
Being crippled and crippling enemies actually mean something now.
Take some cover.
New from Vault-Tec, Amplified Crippled Effects, or ACE, works towards making crippling limbs a very viable thing to do in combat.Cripple an enemies legs, and they slow to a crawl. Cripple the arms, and their aim goes way off. Cripple the head to reduce their aim by half blinding them. Cripple the torso, and their strength and endurance drop sharply, the enemy stumbles when you hit their already broken ribs and pound their guts.Of course, this works the opposite way around. If you get a leg crippled, you will soon find yourself limping through the wasteland and with your head crippled you will find it hard to see.
**TRIAGE**
http://www.fallout3nexus.com/downloads/file.php?id=5867
Triage is a medical mod designed to find the balance between the very simplistic means of healing crippled limbs that exists in Fallout 3, without bogging the player down in complex treatment options and medical supplies. (One of my favorites)
**Realistic Gunshot Sounds**
http://www.fallout3nexus.com/downloads/file.php?id=23
Provides realistic sounds for many many many guns. no more of that phony sheit. Also make sure to DL his reload add on as well.
**Fallout 3 Re-Animated**
http://www.fallout3nexus.com/downloads/file.php?id=7670
NO MORE SLOUCHING YOU LAZY BASTARD! (Much needed mod)
Redoes the animations so characters don't look like idiots with their weapons or action figures.
**Crosshair Toggle**
http://www.fallout3nexus.com/downloads/file.php?id=9037
Toggles crosshair on and off with dynamic settings.
Also just in case somebody wants to try the Wanders edition mod here it is.
http://www.fallout3nexus.com/downloads/file.php?id=2761
[spoiler:d990f2d21f]OVERALL GOALS
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* Richer character development + RPG experience where SPECIAL, skill, and Perk choices matter more
* Faster paced and more unforgiving combat for an enhanced FPS experience
* Greatly improved the "survival" aspect of the game, including injuries, loot rarity, and daily needs
* New equipment and a complete rebalance of all weapons, armor, and other gear
* Improvements to the diversity, character, and behavior of many actors, factions, and creatures
* Overall a more immersive game experience
* In-game "Control Panel" and optional modules allow you to configure FWE to your preferred playstyle
* Compatiblity support for other popular mods including MMM, WMK, EVE and Project Beauty
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CHARACTER
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* Built-in alternative start option
* Slower experience, leveling, and pacing choices (configurable)
* SPECIALS's made more important to your character's skills and abilities
* Adjusted carrying weight capacity (configurable)
* Major rebalance of existing perks and new FWE-specific perks
* Tagged skills are more important
* Reduced skill points overall, so characters can't be a master of everything (configurable)
* Skills matter more to your performance in most situations (configurable)
* Adjusted bobblehead bonuses and functionality (configurable)
* Additional lockpicking + hacking choices (bypassing terminals, explosive entries)
* Sneaking made more realistic and challenging (configurable)
* Improvement to the karma system
* Changed health formulas for the player for better balance (configurable)
* Improved barter settings for a more balanced economy (configurable)
* Skill books now provide unique perks instead of skill points
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COMBAT
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* Greatly increased the global damage multiplier for damage taken and dealt (configurable)
* Significantly lessened the effect of auto-aim
* Adjusted the weapon spread (accuracy formula) for better gameplay (configurable)
* Unarmed skill provides a "dodge" bonus when wearing lighter armors
* Implemented body-part location based damage specific to each NPC/creature type
* Reduced limb explosion + dismemberment rates
* VATS balancing, including increased player damage and adjusted hit %
* Optional VATS real-time and half-time modules
* Movement speed increased
* Backwards movement speed dependent on agility
* Integrated Bullet time feature that consumes AP's (configurable)
* Integrated Sprinting feature that uses AP's (configurable)
* Adjusted Action Point pool size and recharge rates (configurable))
* Built-in FPS-style grenade hotkey mod (configurable)
* More realistic falling damage (configurable)
* Greatly increased velocity and range of projectiles
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EQUIPMENT
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* Over 40 new weapons added from prior fallout games and to the gameworld
* Over a dozen new armors added, appropriate to the fallout setting
* Missing unique weapons + armor added to the wasteland
* Complete rebalance of all weapons, all weapons now have a viable purpose
* Complete rebalance of all explosives for greater stopping power and realism
* Explosions and super sledges now have a knockdown effect
* Complete rebalance of all armor for greater range of viable armor choices
* Power armor overhaul, making PA potentially more powerful but more difficult to acquire
* Power armor + recon armor helmets have night vision capabilities
* Weight of armor is reduced when equipped
* Adjusted weapon and armor wear rates (configurable)
* Weapons more likely to jam on reload or firing when in poor condition
* Greatly expanded the repair parts lists for fixing weapons + armor
* Added many new CRAFT'able items to the workbench
* Ammo is significantly more rare (configurable)
* Ammo now has weight so you can't carry mountains of it around (configurable)
* Rebalanced the value and weight of misc items
* Optional worn weapon's module makes good condition weapons much rarer
* New portable lab kits and infirmaries for sale
* New bedroll, water purifier, and portable grills for sale
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SURVIVAL
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* Over 40 new chems and drugs added to the gameworld in vendor and loot lists
* Significantly increased the negative effects of crippled limbs
* New healing system (Triage) for fixing crippled body parts (configurable)
* Stimpaks and other drugs are much more rare (configurable)
* Complete rebalance of all drug and chem effects. Chems how have weight.
* Stimpaks heal over time instead of instantly
* Morphine and certain other drugs allow you to temporarily ignore crippled effects.
* Radiation is much more dangerous and accumulates faster (configurable)
* Sleeping recovers health/condition depending on time spent sleeping (configurable)
* Built-in Primary Needs feature, requiring you to eat, drink, and sleep on a regular basis (configurable)
* New drug visual effects (configurable)
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ACTORS
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* Improved enemy AI and combat performance
* Complete overhaul of faction equipment lists for greater faction diversity and character
* Most creatures have one or more perks, making them tougher and more dangerous
* Improved the survivability and look of trade caravans
* Optional enhanced follower module adds multi-follower support and expands their functionality
* Most repair vendors have a higher repair skill
* Tweaked NPC/Creature health formulas and base health
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IMMERSION
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* Many standard containers now respawn across the wastes
* Slower timescale (configurable)
* Increased the global respawn timer to 7.5 days (configurable)
* Vendors respawn independently of the global respawn timer (configurable)
* Fast travel can be disabled (configurable)
* Optional fast travel alternative system, including a new fast-travel motorcycle and travel caravans
* Built-in weapon scanner mod to display accurate weapon stats in the pip-boy (configurable)
* Skill books don't "disappear" after being read
* New bobblehead stand and fully havoc'd bobbleheads
* Tracers removed from most projectiles (optional)
* Improved the balance and of range of choices for the outcast tech quest reward quest
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SUPPORT
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* Support for all DLC's, new features and balance changes extended to all DLC content
* Support for Weapon Mod Kits (see FOIP)
* support for Mart's Mutant Mod (see FOIP)
* Support for Energy Visuals Enhanced (see FOIP)
* Support for Project Beauty (see FOIP)[/spoiler:d990f2d21f]