The year started off with high hopes for VIVUS, Inc. (NASDAQ:VVUS). The biotech had just launched its obesity drug Qsymia, and while there were some challenges -- mainly an FDA requirement to only sell the drug through mail-order pharmacies -- the agency appeared open to giving VIVUS more flexibility in marketing the drug.

The approval to sell Qsymia in retail pharmacies came in July, about a month after VIVUS's biggest competitor, Belviq from Arena Pharmaceuticals, Inc. (NASDAQ:ARNA) and Eisaihit the market. The showdown was set.

Except neither actually won.

Both drugs have gotten off to an extremely slow start. Slow uptake by doctors combined with high out-of-pocket expenses, which are often covered by the drug makers, have led to pretty paltry sales. VIVUS's Qsymia had sales of just $6.4 million in the third quarter. Arena's Belviq wasn't any better at $5.4 million.

Leadership change (x2)
A drug not living up to its potential? That's the kind of thing activist investors dream about.

In June, First Manhattan launched a proxy battle to get its slate onto the board of director. After a month, it was clear First Manhattan was going to win, so management conceded, giving First Manhattan majority control of VIVUS's board.

As ammunition for the proxy fight, First Manhattan had signed up Anthony Zook to take over as CEO if the activist investors gained control of the company. As part of the compromise to end the proxy battle, Anthony Zook became VIVUS's CEO.

His tenure was short lived though. In September, VIVUS announced a second management change, giving the new role to Seth Fischer after Zook stepped down for health reasons.

Fisher hasn't produced the marketing partner that First Manhattan says VIVUS needs to compete with Arena Pharmaceuticals and Orexigen Therapeutics, Inc. (NASDAQ:OREX). Arena is teamed up with Eisai, and Orexigen's obesity drug Contrave will be sold by Takeda Pharmaceuticals once it's approved.

VIVUS did partner its erectile-dysfunction drug Stendra with Auxilium Pharmaceuticals, Inc. (UNKNOWN:AUXL.DL) in the U.S. and a second deal with Italian pharma Menarini that covers Europe, Australia, and New Zealand. Getting the drug on the market and out of VIVUS's hands commercially was a good move and brought in a little non-dilutive cash. But Stendra was never going to be a major revenue source for VIVUS given the established competition from Viagra and Cialis.

For VIVUS to have a better year in 2014 than it did in 2013, the biotech clearly needs to find a marketing partner willing to put some muscle into marketing Qsymia. There's potential in the obesity drug market, but it's going to take some time and a lot of energy to reach its full possibilities.