The Bear Grylls approach proves essential in Hardcore Mode, perhaps the most striking and beneficial addition to the game. Activated at the start, it plays up the survival aspect by introducing numerous realistic variables to your game. You need to eat, drink and sleep: hunger, thirst and sleep deprivation will hinder, disorient and eventually kill you if you don't keep on top of them. Ammo has weight in Hardcore Mode, so you can't merrily stuff your pockets with every shell and bullet you find. Efficient inventory planning soon becomes a pressing requirement.
Most importantly, healing items no longer instantly top up your health, but fix you over time, forcing you to be much more tactical in your confrontations. Crippled limbs must be fixed using the rare Doctor's Bag item or patched up by an actual doctor. You can't simply dash in and spam the hotkey for stimpacks during a fight, but have to really think about how you can take down, say, a cellar full of hulking Nightkin without being squished into a fine paste.
It's a brilliant decision, and one that fits perfectly with the aesthetic of the game, forcing you to fully engage with its radiation-scorched landscape. Before, food and water were simply optional health pick-me-ups. Now they form a balancing act, as you weigh up the benefits of curing dehydration sickness with the radiation poisoning you'll get from slurping out of a manky old sink. It's also great to see an extra layer of difficulty that doesn't rely on simply making your enemies bulletproof (yes, Mass Effect, that means you) but instead forces you to play smarter, rather than harder.
Maybe when the next-gen occurs we can finally dump that crappy engine and get back to pushing the boundaries of technology.