Food transport refrigeration is a critical link in the food chain not only in terms of maintaining the temperature integrity of the transported products but also its impact on energy consumption and CO2 emissions. This paper provides a review of (a) current approaches in road food transport refrigeration, (b) estimates of their environmental impacts, and (c) research on the development and application of alternative technologies to vapour compression refrigeration systems that have the potential to reduce the overall energy consumption and environmental impacts. The review and analysis indicate that greenhouse gas emissions from conventional diesel engine driven vapour compression refrigeration systems commonly employed in food transport refrigeration can be as high as 40% of the greenhouse gas emissions from the vehicle’s engine. For articulated vehicles over 33 ton, which are responsible for over 80% of refrigerated food transportation in the UK, the reject heat available form the engine is sufficient to drive sorption refrigeration systems and satisfy most of the refrigeration requirements of the vehicle. Other promising technologies that can lead to a reduction in CO2 emissions are air cycle refrigeration and hybrid systems in which conventional refrigeration technologies are integrated with thermal energy storage. For these systems, however, to effectively compete with diesel driven vapour compression systems, further research and development work is needed to improve their efficiency and reduce their weight.