The "Welcome To The Wasteland" Balance Mod is best used with HARD and VERY HARD difficulty, and contains within it all elements of the Fallout3PaceMod, my XP reducing mod.
It is savegame compatible but makes most sense with a brand new game.
In fact it might not make any sense at all in an already advanced game, because its whole point is to slow down your characters growth in power and make the world seem more threatening and harsher.
The Balance Mod rebalances game systems in Fallout3 in order to give the player more and harder choices to make in the game.
Food, radiation, barter skill, 'regular' skill perks (rather than Educated) are now all IMPORTANT parts of the game. (unlike in vanilla where food is aesthetic and radiation a non-issue).
Short Gameplay Explanation*
You will no longer get a new level every 10 minutes.
You'll need to do more quests in order to level up fast.
Those XP raising perks might actually be useful (though I still wouldn't take em).
You no longer get stims and meds and equipment wherever you go.
Even ammo is somewhat harder to find, and more expensive.
Now you'll be scrounging whatever you can get from fallen enemies and the environment so you can go and sell it to buy some more meds or ammo at early stages.
You won't be carrying a huge load of everything. medicine has weight now, and you need food which is also weighted. think carefully about how much you want to put in Strength, or alternatively in Barter skill and Charisma.
You'll sigh with relif whenever a quest gives a big payout, knowing that for a while yet you'll have the equipment you need.
Vanilla-Unecessary skills like Barter are suddenly very good to have, and skill points are that little bit more precious now that you can't cheat with clothes or get the educated perk. Unless you specialize a bit more, chances are some of those locks or terminals might actually be out of your reach now.
You'll be irradiated by the food you now must eat to survive and by the more dangerous environment and creatures.
You'll sing praise of a high medicine skill for increased radaway effects. Radiation penalties are more severe as well.
Your crippling injuries will last a while longer during exploration because stimpacks will either be hard to get and valuable.
You'll no longer step out of the vault with 16 stims and 200+ 10mm bullets.
You'll step out of there with very little more than the clothes on your back, and you'll have to be couragous indeed to go straight to bandit hideouts.
Trekking through the wasteland feels much more like.. well, trekking through a wasteland.
If you don't take care, you'll run out of supplies, and that is bad.
You won't step out of springvale elementary with a kings ransom of medicine and stimpacks now. you'll be happy enough just to get the guns and armor off of raiders in order to sell for food and ammunition.
That's the kind of balance im talking about.
What I've done is rebalance the importance of various skills, perks, abilities, food, medicine and radiation, in addition to various misc. changes that support this:
1) Made food much more healthful and more irradiated. (food is now a main source of HP and it's important to stock up at your local tavern for long treks)
2) Made stimpacks very rare, ultrapowerful and very expensive. (more like FO2. remember how expensive stims were in the first half?)
3) All medicine now weighs 0.5, and food weights have been adjusted as well (most are 0.5 but some are 0.1, no more huge stockpiles, you'll have to decide between guns/meds/food/armor etc now.)
4) Changed the 'enchantment' quality of nearly all clothes and armor (no more +5 repair vaultsuit. some armors such as power armor now have more damage resistance quality, etc. no more changing suits to repair your weapons.)
5) Increased accumulation rate of radiation in irradiated areas and when swimming in water (use protection of any kind you can get)
6) Changed radiation/hp values for drinking from sinks (more rad. finding food is better now.)
7) Food Sanitizer now has a great effect on unpurified water and overall better usage. also weighs a lot less, worth a lot more (sell it? keep it? hmm)
Rebalanced some overpowered perks like Educated, Explosives Expert. (those 'regular' skill perks might seem more appealing now!)
9) A bit less ammo boxes in the game, but more ammo at vendors (little boost to melee chars and more of that fallout wasteland feel)
10) Bullets price value raised to rebalance weapon availability (early game guns bullets more expensive, but the stronger the weapon, ammo prices raise exponentially. this is done to restrict the player from having *reliable* use of high level weaponry too early on, and give a more gradual feeling to weapon use)
11) Combined with the PaceMod. less xp for combat/hacking/lockpicking, more for finding new locations. (exploring is better encouraged but you can explore much more before capping out)
12) Shifted things around so that you'll find less loot around your starting area. exploring further is harder, much harder, but has its rewards too.
13) Rebalanced some of the more ridiculously overpowered items and weapons.
14) Removed many skill books (300 something is frankly insane. as hard as they are to find, I must accept that for replay value alone, there better be less)
15) Reduced caps generation in random loot
16) increased the effects of SPECIAL abilities on stats like HP points, carry weight and VATS points
17) Slightly more damage to player in VATS mode
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Removed some exploits like the free purified water from housebots
19) Lowered the rewards of some quests, especially freeform ones.
20) moved many (as many as i could find) 'ladykiller' and 'black widow' special dialogue to CHARISMA checks (more fallouty, more sensible, charisma less useless). Changed some speech checks to charisma or added another optional for a charisma check instead.
21) Small XP awards for successful intelligence/various stat in conversations (not all)
22) Removed free purified water from housebots
23) My First Infirmary no longer cures radiation poisoning (doctors, radaway and rad protection are all you got now)
24) Sleep no longer restores limb damage (THANK YOU KSCHENK!)
25) Auto-aim help is reduced by a very small fraction
26) You get 1 skill point per 2 INT points, and 3 more skill points per level (Thanks Xodarap for making this perk!)
27) Followers use ammo and are generally weaker --- they're an investment. they're incredibly powerful so long as you keep them alive and with weapon. They're also less aggressive. they wont run around trying to clear fort constantine on their own, but they will defend you and themselves. They start with a good ammount of ammo, however, and will pick up guns from fallen enemy themselves when in combat and out of ammo.
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Caravans and their guards are tougher. They'll survive a radscorpion attack in high levels now. probably.
All in all, many changes big and small that make fallout3 a harder game amd the fallout3 world a harsher, less forgiving world.