We should blame and stigmatize people for conditions where blame and stigma are the most useful methods for curing or preventing the condition, and we should allow patients to seek treatment whenever it is available and effective.

I think you said it better earlier when you talked about whether the reduction in incidence outweighs the pain caused by the tactic. For some conditions, if it wasn't for the stigma there would be little-to-nothing unpleasant about it (and we wouldn't need to talk about reducing incidence).

I agree with your general principle, but think it's unlikely that blame and stigma are ever the most useful methods. We should be careful to avoid the false dichotomy between the "stop eating like a pig" tactic and fat acceptance.

Sandy's husband is an asshole, who probably defends his asshole behavior by rationalizing that he's trying to help her. He's not really trying to help her (or if he is, he knows little about psychology (or women)).

Blame and judgment are such strong signaling devices that I think people rarely use it for the benefit of the one being judged. If it happens to be the best tactic for dealing with the problem, well, that would be a quite a coincidence.

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I liked your post a lot, in case that wasn't clear. I think you are focusing on the right kinds of questions.