Global food systems face complex, multi-faceted challenges that greatly vary by context, and their environmental, health, and socio-economic impacts are equally diverse. A comprehensive understanding that integrates these disparate factors into unified, clear guidance is essential for decision-making, including policy measures and industry practices. True Cost Accounting (TCA) methodologies aim to meet this need by quantifying a wide spectrum of food systems-related benefits and costs in economic terms. We reviewed existing TCA frameworks, approaches, methods, and data sources used for measuring and monetising environmental externalities generated by food production and consumption. Our analysis of 85 recent publications (2018–2025) revealed several key patterns in current research. The literature shows a predominant focus on negative impacts, with greenhouse gas (GHG) emissions receiving primary attention. Studies mainly examined cereals, meat, and dairy, mostly in high-income and upper-middle-income country settings. TCA assessments employed three main methodological approaches: granular bottom-up, large-scale top-down, or comparative approaches, to capture environmental externalities.