Background <p>Sarcopenic obesity (SO), a metabolic disorder, may establish a bidirectional vicious cycle with stroke. However, the relationship between SO and stroke remains unclear. This study aims to analyze the association between these two diseases and to investigate the moderating effect of healthy lifestyle.</p> Methods <p>This cross-sectional study used data from the 2015 China Health and Retirement Longitudinal Study database. Participants meeting the inclusion criteria were classified based on the 2019 Asian Working Group for Sarcopenia (AWGS) criteria, and their history of stroke was recorded through questionnaires. The lifestyle assessments were based on four dimensions: smoking status, alcohol consumption, social engagement, and sleep duration. Logistic regression models examined the association between possible SO and stroke and the moderating role of a healthy lifestyle. Finally, a sensitivity analysis was performed.</p> Results <p>A total of 5,401 individuals were included in the study, 185 of whom were diagnosed with possible SO. Compared to the non-SO group, the SO group had significantly higher rates of diabetes mellitus, cardiac disease, stroke, fall history, and drug use. Logistic regression analysis revealed a significant association between possible SO and stroke (<i>OR</i> = 2.42, <i>95%CI</i>: 1.43–4.11, <i>P</i> = 0.001). The association was weaker in the high score healthy lifestyle subgroup (<i>OR</i> = 2.38, <i>95%CI</i>: 1.21–4.70, <i>P</i> = 0.01) than in the low score subgroup (<i>OR</i> = 2.43, <i>95%CI</i>: 1.02–5.80, <i>P</i> = 0.045). Sensitivity analyses confirmed the stability of the results.</p> Conclusion <p>This study provides evidence that possible SO is significantly associated with stroke. Adhering to a healthy lifestyle, including abstaining from smoking and alcohol consumption, engaging in social activities, and maintaining adequate sleep, might attenuate this association.</p> Clinical trial registration <p>Not applicable.</p>