Well, it ends up being the same as VS, but you need to manually do it.
Step 1: Create a new Project using the OS X -> Other -> Empty template. (I put this project in handmade/misc/osx/HandmadeHero.xcodeproj).
Step 2: Create a new scheme (I named mine Handemade Hero)
Step 3: Edit the scheme, under "Run", set the executable to the path to your binary
This allows you to debug the executable now. To break on main, add a symbolic breakpoint.
Debug -> Breakpoints -> Create Symbolic Breakpoint
For the name, enter "main" (or whatever function you want to break on).
[Edit] I've attached a sample.