Usually means: Extremely skinny, almost emaciated-looking.
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We found 6 dictionaries that define the word thin as a rake:

General (3 matching dictionaries)
  1. thin as a rake: Oxford Learner's Dictionaries
  2. thin as a rake: Wiktionary
  3. thin as a rake: TheFreeDictionary.com

Computing (1 matching dictionary)
  1. thin as a rake: Encyclopedia

Medicine (1 matching dictionary)
  1. thin as a rake: Medical dictionary

Miscellaneous (1 matching dictionary)
  1. thin as a rake: Idioms

Definitions from Wiktionary (thin as a rake)

adjective:  (simile) Incredibly thin, at an unhealthy-looking level of thinness.

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