I play with it in the background, no mods or tilesets. but one thing that genuinely weirds me out is the people who say that they have a hard time keeping their dwarves from starving to death. i've never had that problem.. i have SO many planters, and I have a system of underground farm plots, like I have the sheer cliff my fort is built into, then out underneath the trees I drain the ponds into the tunnels, then close the gap with a floodgate and build a big farm plot for mushrooms. I have many, many farm plots like this, and I utilize the caverns making moss so I can get places far from water to produce crops, and have large areas in the aforementioned area 1 z level underground completely mined out to grow trees. Ontop of this it produces bushes for my herbalists.
When I'm not tooling with that I usually am designating trees for cutting, bushes for picking, places for room mining/smoothing/engraving or tooling with a way to make one whole section of the fortressed able to be sealed while having another continue on, and messing with traps and bottlenecks and various defensive designs necessary for the sieges I bring upon myself (not to mention megabeasts and the lot).
as an aside, I've also stopped using danger rooms as they detract all of the tension of a siege, and instead use systems of traps, hallways, fortifications and well-placed ballistae to break sieges.
basically, food manages itself, i make sure I have booze production cranked up to 10 (hard time keeping up with all the needed barrels). I make most dorfs stone crafters or military, the rest doing their own professions, and only really need to micro-manage my steel industry..
Also, I do delve for the beautiful blue metal, but only in limited amounts as you can mine MUCH and not release the circus. But I don't do any artifact manipulation, only savescum particularly when doing !!Science!! with a well established (played many hours) fort, and keep a few worlds on the back burner for doing amusing things like putting [DRAGONFIREBREATH] on elves and badgers
so I'm not sure where that puts me.