The increasingly industrialized global food system has caused detrimental health, environmental, social, and economic impacts. In response to this, experts in public health, environment, agriculture and life cycle analysis developed True Cost Accounting (TCA) as a comprehensive research mechanism for evaluations and assessments to inform policies and programs aimed at positive change. TCA is a multi-stakeholder, systems approach to measure the costs and benefits of different agricultural production systems. In ideal circumstances, evidence from TCA is put into practice to educate key food systems stakeholders such as policymakers, farmers and consumers to work toward a resilient and regenerative food system that supports public health, communities and ecosystems. This paper provides an overview of the most prominent TCA publications and identifies consensus and differentiation regarding definitions, frameworks and approaches. The report also provides recommendations for future research to address gaps in TCA literature and to strengthen future TCA initiatives and organizing.