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There are so many food items in the game, but they all only add 1 or 2 HP plus Rads. Is there any reason to use them? Seems the same with healing powder. And why do they 'wear off' after a while?

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That +1 or +2 you see are actually how much they heal per tick. Essentially, they're heal-over-time items. So when you see +1(20s), this means that you recover 1 health per second for 20 seconds, or 20 health total. This means that health items tend to be the best healing items you can find since they're not as expensive as Stimpaks, which should be saved for emergencies or when you get limb damage.

When playing on Hardcore, food items become even more valuable as traveling the Mojave will incur hunger. As you get hungrier, your stats are reduced and you will die when you reach 1000 Hunger. Eating food will reduce your hunger, keeping you alive in the Wasteland.

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    Just to clarify: hunger is only apparent in New Vegas. Even on the hardest setting you'll never get hungry or thirsty in Fallout 3
    – Robotnik
    Jan 23, 2014 at 23:39
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I'm currently playing a profile on hardcore for the first time and food is necessary, no question. But I find food very useful at times in normal mode. I typically don't carry all my food because of weight but I would always keep a few items that give a good amount of health. I save my Stimpaks for when I'm in combat, when I have broken limbs, or if theres no other source of health. Like Robotnik said, they're a lot cheaper than Stimpaks. And food is pretty much the most commonly found source of health

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