Instead of chasing realism it does far more to seek to give a feeling of realism.
So instead of creating complicated tangled rules to try and replicate the real world (old AD&D is particularly guilty of this) I prefer to work with simpler mechanics that can be used to give the world weight and a sense of reality, even if they do not necessarily simulate it.
Slot based encumbrance is a good example of this line of thinking. Whereas some versions of D&D have sought the (arguably) more realistic route of counting up all the individual weights of items and tallying them up, I instead use a slot based system where particular items take up one slot.
Sure its less "realistic" but mechanically its simpler, easier to use and remember and story-wise it has much the same affect.
Another example would be Dungeons that "make sense." Dungeons are a fantastical construct and so don't really adhere to the rules of reality quite well. To make a truly realistic dungeon would be to make a relatively boring one. But by still thinking logically about the fantastical environment. Where are the choke points? Where's water come from? You can anchor even a fantastical dungeon into the world and provide more ways for players to interact with it.
And at the end of the day, there is the matter that the game is fundamentally one of fantasy and the imagination. It does not necessarily need to operate under the normal rules of reality. After all we already have magic and it can be awesome to have a fighter cleave a foe straight in two even if that isn't the most "realistic."
Ultimately verisimilitude or realism are merely tools to make our worlds feel more real, more lived in, to give weight and consequence.