The phrase is an exaggeration and not to be taken literally. It indicates eating voraciously, not actually like a horse. When I saw him at the buffet, he was eating like a horse.
Pro Tip 2/3
Focus on Quantity
Use the phrase to stress the large amount being eaten more than the manner of eating. Although she's small, she can eat like a horse.
Pro Tip 3/3
Informal Context
It's informal and usually used in casual conversations, not in formal or polite settings. We need to prepare a lot of food for the picnic since Jake eats like a horse.